Provider Demographics
NPI:1053796946
Name:SOUTHERN NEVADA ACADEMY OF DEVELOPMENT AND BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SOUTHERN NEVADA ACADEMY OF DEVELOPMENT AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DINISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGO
Authorized Official - Suffix:
Authorized Official - Credentials:B,A, QMHA
Authorized Official - Phone:702-373-7248
Mailing Address - Street 1:5005 LOSEE RD
Mailing Address - Street 2:UNIT 3046
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2479
Mailing Address - Country:US
Mailing Address - Phone:702-373-7248
Mailing Address - Fax:
Practice Address - Street 1:5005 LOSEE RD
Practice Address - Street 2:UNIT 3046
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2479
Practice Address - Country:US
Practice Address - Phone:702-373-7248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151439330251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health