Provider Demographics
NPI:1366744310
Name:COUNSELING AND AWARENESS REHABILITATIVE EDUCATIOANL PROGRAM INC.
Entity type:Organization
Organization Name:COUNSELING AND AWARENESS REHABILITATIVE EDUCATIOANL PROGRAM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC, SUP
Authorized Official - Phone:702-877-9850
Mailing Address - Street 1:1240 W OWENS AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2452
Mailing Address - Country:US
Mailing Address - Phone:702-877-9850
Mailing Address - Fax:702-877-9870
Practice Address - Street 1:1240 W OWENS AVE
Practice Address - Street 2:STE. 3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2452
Practice Address - Country:US
Practice Address - Phone:702-877-9850
Practice Address - Fax:702-877-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NVL791103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty