Provider Demographics
NPI:1841067691
Name:SOURCE ENERGY CONSULTANT SERVICES LLC
Entity type:Organization
Organization Name:SOURCE ENERGY CONSULTANT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALTAMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:702-499-6401
Mailing Address - Street 1:800 N RAINBOW BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1193
Mailing Address - Country:US
Mailing Address - Phone:800-493-0172
Mailing Address - Fax:
Practice Address - Street 1:800 N RAINBOW BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1193
Practice Address - Country:US
Practice Address - Phone:800-493-0172
Practice Address - Fax:800-493-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty