# THE VILLAGE BEHAVIOR HEALTH SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003173196
- **Authorized official:** MR. RANDY FULTON (CO OWNER)
- **Authorized official phone:** (619) 206-0963

## Contact information

- **Practice address:** 6330 MCLEOD DR, SUITE 4&5, LAS VEGAS, NV 89120-4430
- **Practice address phone:** (702) 437-0341
- **Mailing address:** 17127 W BERNARDO DR, UNIT 207, SAN DIEGO, CA 92127-1513
- **Mailing address phone:** (619) 206-0963

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 04/13/2012
- **Last updated:** 04/13/2012