Provider Demographics
NPI:1285269100
Name:THE PSYCHOLOGY INSTITUTE OF LAS VEGAS PLLC
Entity type:Organization
Organization Name:THE PSYCHOLOGY INSTITUTE OF LAS VEGAS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREGGI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-546-9600
Mailing Address - Street 1:2451 S BUFFALO DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2749
Mailing Address - Country:US
Mailing Address - Phone:702-546-9600
Mailing Address - Fax:702-829-8065
Practice Address - Street 1:2451 S BUFFALO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2749
Practice Address - Country:US
Practice Address - Phone:702-546-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215147673Medicaid
1215147673OtherNPI