Organization
1111 THERAPY & MENTAL HEALTH INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY BUMPERS M.ED (MANAGER)
(404) 849-9918
Entity
Organization
Contact information
Practice address
1504 BLACKCOMBE ST UNIT 204, LAS VEGAS, NV 89128-8019
(404) 849-9918
Mailing address
1504 BLACKCOMBE ST UNIT 204, LAS VEGAS, NV 89128-8019
(404) 849-9918
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
—
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
2084P0015X
Psychosomatic Medicine Physician
—
—
221700000X
Art Therapist
—
—
225400000X
Rehabilitation Practitioner
—
—
225600000X
Dance Therapist
—
—
225A00000X
Music Therapist
—
—
225C00000X
Rehabilitation Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245755636
—
NV
05
—
1821367087
—
NV
Enumeration date
08/06/2021
Last updated
08/06/2021
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