Organization
ESSENTIAL BEHAVIOR & SKILLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA B. BECERRA-BAUTISTA (DIRECTOR)
(702) 883-0722
Entity
Organization
Contact information
Practice address
5615 CAMERON ST, STE 7, LAS VEGAS, NV 89118-2233
(702) 883-0722
Mailing address
5615 CAMERON ST, STE 7, LAS VEGAS, NV 89118-2233
(702) 883-0722
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720385222
—
NV
Enumeration date
04/23/2012
Last updated
09/21/2012
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