Provider Demographics
NPI:1053688283
Name:HENDERSON SUBSTANCE ABUSE TREATMENT CENTER
Entity type:Organization
Organization Name:HENDERSON SUBSTANCE ABUSE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:702-565-6060
Mailing Address - Street 1:2 IDAHO WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7209
Mailing Address - Country:US
Mailing Address - Phone:702-565-6060
Mailing Address - Fax:702-565-6097
Practice Address - Street 1:2 IDAHO WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7209
Practice Address - Country:US
Practice Address - Phone:702-565-6060
Practice Address - Fax:702-565-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00309-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty