Organization
IMPACT INTERVENTIONS BEHAVIORAL HEALTH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRELL TELLIS (MANAGER)
(702) 573-5813
Entity
Organization
Contact information
Practice address
8109 IVY HOLLOW CT, LAS VEGAS, NV 89143-5168
(702) 573-5813
Mailing address
8109 IVY HOLLOW CT, LAS VEGAS, NV 89143-5168
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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