Organization
GOOD MEDICINE RANCH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY A DAVIS CPCI (MANAGER)
(702) 626-9400
Entity
Organization
Contact information
Practice address
2400 N TENAYA WAY, LAS VEGAS, NV 89128-0420
(702) 626-9400
Mailing address
4716 ANCHORAGE ST, LAS VEGAS, NV 89147-5101
(702) 626-9400
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C10154
NV
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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