Basic Information
| Provider Information | |||||||||
| NPI: | 1871043687 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CSSI BEHAVIORAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3620 N RANCHO DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891303155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026394400 | ||||||||
| FaxNumber: | 7026394403 | ||||||||
| Practice Location | |||||||||
| Address1: | 3620 N RANCHO DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891303155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026394400 | ||||||||
| FaxNumber: | 7026394403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2016 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | TELLIS | ||||||||
| AuthorizedOfficialFirstName: | PHYLLIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7026394400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 8182PCS-0 | NV | Y | Agencies | Home Health |
No ID Information.