Provider Demographics
NPI:1538840384
Name:EXPERIENCE COURAGE THERAPY AND CONSULTING DBA LAS VEGAS PLAY THERAPY
Entity type:Organization
Organization Name:EXPERIENCE COURAGE THERAPY AND CONSULTING DBA LAS VEGAS PLAY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT, RPT-S
Authorized Official - Phone:702-630-8848
Mailing Address - Street 1:2655 S RAINBOW BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5100
Mailing Address - Country:US
Mailing Address - Phone:702-630-8848
Mailing Address - Fax:
Practice Address - Street 1:2655 S RAINBOW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5100
Practice Address - Country:US
Practice Address - Phone:702-630-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty