Provider Demographics
NPI:1386273340
Name:PHOENIX BEHAVIORAL GROUP LV LLC
Entity type:Organization
Organization Name:PHOENIX BEHAVIORAL GROUP LV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YESICA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-202-4442
Mailing Address - Street 1:1670 E FLAMINGO RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5120
Mailing Address - Country:US
Mailing Address - Phone:702-202-4442
Mailing Address - Fax:888-857-3788
Practice Address - Street 1:1670 E FLAMINGO RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5120
Practice Address - Country:US
Practice Address - Phone:702-202-4442
Practice Address - Fax:888-857-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty