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Organization
ST MARY BEHAVIORAL SERVICES INC
Active
Organization
ST MARY BEHAVIORAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ISAAC MUTABAZI (DIRECTOR)
(702) 849-2173
Entity
Organization
Contact information
Practice address
7728 CORONADO ISLAND ST, LAS VEGAS, NV 89139-6298
(702) 849-2173
Mailing address
7728 CORONADO ISLAND ST, LAS VEGAS, NV 89139-6298
(702) 849-2173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
NULL
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
251B00000X
Case Management Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
10/11/2023
Last updated
10/11/2023
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