Provider Demographics
NPI:1992567606
Name:SANDRA PIERRE LOUIS DIVINE SOUL MENTAL HEALTH PIERRE-LOUIS PLLC
Entity type:Organization
Organization Name:SANDRA PIERRE LOUIS DIVINE SOUL MENTAL HEALTH PIERRE-LOUIS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIERRE-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:702-551-4617
Mailing Address - Street 1:9620 S. LAS VEGAS BLVD, SUITE E-4 #1211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-551-4617
Mailing Address - Fax:
Practice Address - Street 1:9550 S EASTERN AVE STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-8045
Practice Address - Country:US
Practice Address - Phone:702-551-4617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty