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Organization
GERONA PORCEL LLC
Active
Organization
GERONA PORCEL LLC
Active
Other names
Light Behavioral Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH BERNAL PEREZ (MANAGING MEMBER)
(702) 272-8619
Entity
Organization
Contact information
Practice address
2110 E FLAMINGO RD STE 205, LAS VEGAS, NV 89119-5192
(702) 620-5105
Mailing address
1912 MAGNOLIA DR, HENDERSON, NV 89014-5192
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
09/20/2019
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