Provider Demographics
NPI:1215172317
Name:PALO VERDE CHILD & FAMILY SERVICES, INC
Entity type:Organization
Organization Name:PALO VERDE CHILD & FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:WULKAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCSW
Authorized Official - Phone:702-243-4357
Mailing Address - Street 1:2801 S VALLEY VIEW BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0116
Mailing Address - Country:US
Mailing Address - Phone:702-243-4357
Mailing Address - Fax:
Practice Address - Street 1:2801 S VALLEY VIEW BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0116
Practice Address - Country:US
Practice Address - Phone:702-243-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health