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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