# NISWONGER PSYCHOLOGICAL HEALTH, LLC

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

## Provider details

- **NPI number:** 1255679312
- **Authorized official:** MS. JODI NISWONGER LCSW (OWNER)
- **Authorized official phone:** (702) 768-2950

## Contact information

- **Practice address:** 7495 W AZURE DR, SUITE \#204, LAS VEGAS, NV 89130-4416
- **Practice address phone:** (702) 768-2950
- **Mailing address:** 7495 W AZURE DR, SUITE \#204, LAS VEGAS, NV 89130-4416
- **Mailing address phone:** (702) 768-2950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 5436-C | NV | Yes |

## Other

- **Enumeration date:** 01/24/2013
- **Last updated:** 01/24/2013