Organization
BLUE 42 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JSHAUNTAE MARSHALL (DIRECTOR)
(775) 538-5104
Entity
Organization
Contact information
Practice address
1230 W OWENS AVE STE 1, LAS VEGAS, NV 89106-2451
(775) 538-5104
Mailing address
8046 PAVAROTTI AVE, LAS VEGAS, NV 89178-8264
(775) 538-5104
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
174N00000X
Lactation Consultant (Non-RN)
—
—
251B00000X
Case Management Agency
—
—
261QB0400X
Birthing Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
374J00000X
Doula
—
—
Other
Enumeration date
03/30/2023
Last updated
06/23/2024
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