# KINGDOM BEHAVIORAL HEALTH, INC

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

## Provider details

- **NPI number:** 1114259355
- **Authorized official:** WILLIE EDWARD JOHNSON LCSW (DIRECTOR)
- **Authorized official phone:** (702) 349-8258

## Contact information

- **Practice address:** 4085 N RANCHO DR STE 120, LAS VEGAS, NV 89130-3467
- **Practice address phone:** (702) 349-8258
- **Practice address fax:** (702) 543-3124
- **Mailing address:** 4085 N RANCHO DR STE 120, LAS VEGAS, NV 89130-3467
- **Mailing address phone:** (702) 836-1905
- **Mailing address fax:** (702) 836-1904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | 5530-C | NV | — |
| 1041C0700X | Clinical Social Worker | 5530-C | NV | Yes |
| 251S00000X | Community/Behavioral Health Agency | 5530-C | NV | — |

## Other

- **Enumeration date:** 02/11/2010
- **Last updated:** 03/22/2011