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Organization
RESURRECTION ENTERPRISE, LLC
Active
Organization
RESURRECTION ENTERPRISE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHUNG HORTON JEFFERSON JD (MANAGING MEMBER)
(702) 382-4061
Entity
Organization
Contact information
Practice address
1448 E CHARLESTON BLVD, LAS VEGAS, NV 89104-1705
(702) 382-4061
Mailing address
PO BOX 12924, LAS VEGAS, NV 89112-0924
(702) 382-4061
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
09/07/2011
Last updated
01/05/2016
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