Provider Demographics
NPI:1194269035
Name:ESPERANZA FAMILY COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:ESPERANZA FAMILY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-680-3586
Mailing Address - Street 1:2465 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7285
Mailing Address - Country:US
Mailing Address - Phone:702-680-3586
Mailing Address - Fax:
Practice Address - Street 1:2465 REYNOLDS AVE # 3
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7285
Practice Address - Country:US
Practice Address - Phone:702-680-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20161335787Medicaid