Organization
OSOM BEHAVIOR MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE E. HARRIS II MS ED. (CEO/PSYCHOSOCIAL REHABILITATIVE SPE)
(702) 981-0391
Entity
Organization
Contact information
Practice address
2616 SLIDE CANYON AVE, NORTH LAS VEGAS, NV 89081
(702) 981-0391
Mailing address
2616 SLIDE CANYON AVE, NORTH LAS VEGAS, NV 89081
(702) 981-0391
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
NV20101771798
NV
Other
Enumeration date
07/28/2011
Last updated
07/28/2011
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