# LIFE GATEWAY

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

## Provider details

- **NPI number:** 1710246921
- **Authorized official:** CYNTHIA EWELL (MANAGING MEMBER)
- **Authorized official phone:** (702) 752-9274

## Contact information

- **Practice address:** 2128 PINK CORAL DR, NORTH LAS VEGAS, NV 89031-0985
- **Practice address phone:** (702) 234-9822
- **Mailing address:** 3605 MOUNTAIN CREST ST, LAS VEGAS, NV 89129-7864

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NV | Yes |

## Other

- **Enumeration date:** 05/08/2012
- **Last updated:** 05/08/2012