Provider Demographics
NPI:1932926763
Name:MARSHALL MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:MARSHALL MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, LCADC-S
Authorized Official - Phone:702-217-5639
Mailing Address - Street 1:6161 SHELTER CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3925
Mailing Address - Country:US
Mailing Address - Phone:702-217-5639
Mailing Address - Fax:702-514-6249
Practice Address - Street 1:2840 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5201
Practice Address - Country:US
Practice Address - Phone:702-217-5639
Practice Address - Fax:702-514-6249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility