Organization
INNOVATIVE COLLABORATION SUPPORT SERVICES, LLC
Active
Organization
INNOVATIVE COLLABORATION SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL DONNELL BRIDGES MA (CLINICAL DIRECTOR)
(702) 476-9405
Entity
Organization
Contact information
Practice address
4400 S JONES BLVD UNIT 1055, LAS VEGAS, NV 89103-3339
(702) 476-9405
Mailing address
4400 S JONES BLVD UNIT 1055, LAS VEGAS, NV 89103-3339
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
251S00000X
NV
Other
Enumeration date
09/03/2010
Last updated
09/03/2010
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