NPIMap

Organization Active NPI

Kingdom Behavioral Health, Inc

  • Clinical Social Worker
  • Las Vegas, NV
National Provider Identifier
1114259355
Registry record updated Mar 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5530-C Issued in NV
Legal business name
KINGDOM BEHAVIORAL HEALTH, INC
Practice address
4085 N Rancho Dr Ste 120
Las Vegas, NV 89130-3467
Phone
(702) 349-8258
Fax
(702) 543-3124
NPI assigned
Feb 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Willie Edward Johnson, LCSW
Title
Director
Phone
(702) 349-8258

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X 5530-C NV
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 5530-C NV Primary
Community/Behavioral Health Agency 251S00000X 5530-C NV

Addresses

Primary practice location

4085 N Rancho Dr Ste 120
Las Vegas, NV 89130-3467

Mailing address

4085 N Rancho Dr Ste 120
Las Vegas, NV 89130-3467
Phone (702) 836-1905

National Provider Directory

National Provider Directory

Locations

4085 N Rancho Dr
Ste 120
Las Vegas, NV 89130
Phone (702) 349-8258

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1114259355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 N RANCHO DR STE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891303467",
            "telephone_number": "702-836-1905",
            "fax_number": "702-836-1904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4085 N RANCHO DR STE 120",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891303467",
            "telephone_number": "702-349-8258",
            "fax_number": "702-543-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM BEHAVIORAL HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-11",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "WILLIE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-349-8258",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NV",
            "license": "5530-C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "5530-C",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NV",
            "license": "5530-C",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.