Provider Demographics
NPI:1982659983
Name:FULLCIRCLE NEVADA, LLC
Entity type:Organization
Organization Name:FULLCIRCLE NEVADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS, ADM, MBR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-303-2503
Mailing Address - Street 1:6170 W LAKE MEAD BLVD
Mailing Address - Street 2:STE. 294
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2661
Mailing Address - Country:US
Mailing Address - Phone:702-303-2503
Mailing Address - Fax:
Practice Address - Street 1:6170 W LAKE MEAD BLVD
Practice Address - Street 2:STE. 294
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2661
Practice Address - Country:US
Practice Address - Phone:702-303-2503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37427Medicare ID - Type UnspecifiedMEDICARE NUMBER