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Organization
LIFE GATEWAY
Active
Organization
LIFE GATEWAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA EWELL (MANAGING MEMBER)
(702) 752-9274
Entity
Organization
Contact information
Practice address
2128 PINK CORAL DR, NORTH LAS VEGAS, NV 89031-0985
(702) 234-9822
Mailing address
3605 MOUNTAIN CREST ST, LAS VEGAS, NV 89129-7864
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NV
Other
Enumeration date
05/08/2012
Last updated
05/08/2012
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