Provider Demographics
NPI:1255636395
Name:WEST LAS VEGAS SCHOOLS
Entity type:Organization
Organization Name:WEST LAS VEGAS SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-426-2554
Mailing Address - Street 1:179 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3495
Mailing Address - Country:US
Mailing Address - Phone:505-426-2554
Mailing Address - Fax:505-426-2782
Practice Address - Street 1:179 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3495
Practice Address - Country:US
Practice Address - Phone:505-426-2554
Practice Address - Fax:505-426-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM271289103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty