Basic Information
| Provider Information | |||||||||
| NPI: | 1649518853 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHILDREN AND ADOLESCENTS MENTORING SERVICES,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2205 SPANISH TOWN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890310903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026589563 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2205 SPANISH TOWN AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890310903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026589563 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | GAINES | ||||||||
| AuthorizedOfficialFirstName: | CHESTER | ||||||||
| AuthorizedOfficialMiddleName: | FRANKLIN | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALIFIED MENTAL HEALTH ASSOCIATE | ||||||||
| AuthorizedOfficialTelephone: | 7026589563 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.