Provider Demographics
NPI:1104313477
Name:ADVANCED BEHAVIORAL AND MENTAL HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL AND MENTAL HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORELLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUMPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-285-1185
Mailing Address - Street 1:8120 DOLCE FLORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8270
Mailing Address - Country:US
Mailing Address - Phone:702-285-1185
Mailing Address - Fax:702-270-9763
Practice Address - Street 1:8120 DOLCE FLORE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-8270
Practice Address - Country:US
Practice Address - Phone:702-285-1185
Practice Address - Fax:702-270-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-22
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health