Provider Demographics
NPI:1215609078
Name:MOMENTUM COUNSELING SERVICES
Entity type:Organization
Organization Name:MOMENTUM COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VASHON
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-I
Authorized Official - Phone:702-807-7319
Mailing Address - Street 1:2235 E FLAMINGO RD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0806
Mailing Address - Country:US
Mailing Address - Phone:702-807-7319
Mailing Address - Fax:
Practice Address - Street 1:2235 E FLAMINGO RD STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0806
Practice Address - Country:US
Practice Address - Phone:702-807-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility