Provider Demographics
NPI:1770960874
Name:SOUTHERN NEVADA BEHAVIORAL HEALTH AUTHORITY LLC
Entity type:Organization
Organization Name:SOUTHERN NEVADA BEHAVIORAL HEALTH AUTHORITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MITRIECE
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:SUMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHA
Authorized Official - Phone:702-586-3050
Mailing Address - Street 1:6883 W CHARLESTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1645
Mailing Address - Country:US
Mailing Address - Phone:702-586-3050
Mailing Address - Fax:702-586-3062
Practice Address - Street 1:6857 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1600
Practice Address - Country:US
Practice Address - Phone:702-586-3050
Practice Address - Fax:702-586-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health