Provider Demographics
NPI:1538541537
Name:GREAT BASIN THERAPEUTIC SERVICES LTD.
Entity type:Organization
Organization Name:GREAT BASIN THERAPEUTIC SERVICES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-622-8280
Mailing Address - Street 1:50 FREEPORT BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 FREEPORT BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6274
Practice Address - Country:US
Practice Address - Phone:775-622-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health