# 1111 THERAPY & MENTAL HEALTH INSTITUTE

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

## Provider details

- **NPI number:** 1831863315
- **Authorized official:** RODNEY BUMPERS M.ED (MANAGER)
- **Authorized official phone:** (404) 849-9918

## Contact information

- **Practice address:** 1504 BLACKCOMBE ST UNIT 204, LAS VEGAS, NV 89128-8019
- **Practice address phone:** (404) 849-9918
- **Mailing address:** 1504 BLACKCOMBE ST UNIT 204, LAS VEGAS, NV 89128-8019
- **Mailing address phone:** (404) 849-9918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101200000X | Drama Therapist | — | NULL | — |
| 101200000X | Drama Therapist | — | — | — |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 2084P0015X | Psychosomatic Medicine Physician | — | NULL | — |
| 2084P0015X | Psychosomatic Medicine Physician | — | — | — |
| 221700000X | Art Therapist | — | NULL | — |
| 221700000X | Art Therapist | — | — | — |
| 225400000X | Rehabilitation Practitioner | — | NULL | — |
| 225400000X | Rehabilitation Practitioner | — | — | — |
| 225600000X | Dance Therapist | — | NULL | — |
| 225600000X | Dance Therapist | — | — | — |
| 225A00000X | Music Therapist | — | NULL | — |
| 225A00000X | Music Therapist | — | — | — |
| 225C00000X | Rehabilitation Counselor | — | NULL | — |
| 225C00000X | Rehabilitation Counselor | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NULL | — |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | — | NULL | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NULL | — |

## Other

- **Enumeration date:** 08/06/2021
- **Last updated:** 08/06/2021