Provider Demographics
NPI:1619229044
Name:BEACON ACADEMY OF NEVADA
Entity type:Organization
Organization Name:BEACON ACADEMY OF NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL/PSYCHOLOGICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:LEP LCSW LMFT LADC
Authorized Official - Phone:702-497-0447
Mailing Address - Street 1:9811 W CHARLESTON BLVD STE 2-345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-726-8600
Mailing Address - Fax:
Practice Address - Street 1:7360 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-5404
Practice Address - Country:US
Practice Address - Phone:702-726-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)