Organization
TOWER BRIDGE DEVELOPMENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA WICKERSHAM (OWNER)
(702) 513-8321
Entity
Organization
Contact information
Practice address
9484 S EASTERN AVE, SUITE 67, LAS VEGAS, NV 89123-3987
(702) 513-8321
Mailing address
9484 S EASTERN AVE, SUITE 67, LAS VEGAS, NV 89123-3987
(702) 513-8321
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053417345
—
NV
05
—
1487953915
—
NV
05
—
1619968021
—
NV
05
—
1679847040
—
NV
05
—
1750642310
—
NV
05
—
1912272527
—
NV
Enumeration date
05/31/2012
Last updated
05/31/2012
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