Organization
FIREBIRD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHUNG HORTON JEFFERSON (MANAGING MEMBER)
(702) 401-3632
Entity
Organization
Contact information
Practice address
601 S 10TH ST, LAS VEGAS, NV 89101-7027
(702) 401-3632
(702) 382-4071
Mailing address
PO BOX 12924, LAS VEGAS, NV 89112-0924
(702) 401-3632
(702) 382-4071
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
10/03/2011
Last updated
04/20/2016
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