Provider Demographics
NPI:1114806486
Name:ALBA BEHAVIORAL HEALTH PC
Entity type:Organization
Organization Name:ALBA BEHAVIORAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-535-7079
Mailing Address - Street 1:3375 S RAINBOW BLVD UNIT 80691
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-8832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:844-305-0320
Practice Address - Street 1:3375 S RAINBOW BLVD UNIT 80691
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89180-8832
Practice Address - Country:US
Practice Address - Phone:702-673-8231
Practice Address - Fax:844-305-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty