Organization
GRACE RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN HARDENBROOK LADC, LADC-S (OWNER)
(702) 370-8912
Entity
Organization
Contact information
Practice address
7729 MAVERICK ST, LAS VEGAS, NV 89131-2113
(702) 370-8912
Mailing address
7729 MAVERICK ST, LAS VEGAS, NV 89131-2113
(702) 370-8912
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
00202-S
NV
101YP1600X
Pastoral Counselor
—
NV
106H00000X
Marriage & Family Therapist
—
NV
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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