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Organization

KINGDOM BEHAVIORAL HEALTH, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WILLIE EDWARD JOHNSON LCSW (DIRECTOR)
(702) 349-8258
Entity
Organization

Contact information

Practice address
4085 N RANCHO DR STE 120, LAS VEGAS, NV 89130-3467
(702) 349-8258
(702) 543-3124
Mailing address
4085 N RANCHO DR STE 120, LAS VEGAS, NV 89130-3467
(702) 836-1905
(702) 836-1904

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
5530-C
NV
1041C0700X
Clinical Social Worker
Primary
5530-C
NV
251S00000X
Community/Behavioral Health Agency
5530-C
NV

Other

Enumeration date
02/11/2010
Last updated
03/22/2011
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