# BLUE 42 INC

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

## Provider details

- **NPI number:** 1902500028
- **Authorized official:** JSHAUNTAE MARSHALL (DIRECTOR)
- **Authorized official phone:** (775) 538-5104

## Contact information

- **Practice address:** 1230 W OWENS AVE STE 1, LAS VEGAS, NV 89106-2451
- **Practice address phone:** (775) 538-5104
- **Mailing address:** 8046 PAVAROTTI AVE, LAS VEGAS, NV 89178-8264
- **Mailing address phone:** (775) 538-5104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 174N00000X | Lactation Consultant (Non-RN) | — | NULL | — |
| 174N00000X | Lactation Consultant (Non-RN) | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261QB0400X | Birthing Clinic/Center | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 374J00000X | Doula | — | NULL | — |
| 374J00000X | Doula | — | — | — |

## Other

- **Enumeration date:** 03/30/2023
- **Last updated:** 06/23/2024