Organization Active NPI

Team Care Corp

  • Psychiatry Physician
  • Henderson, NV
National Provider Identifier
1366058067
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
TEAM CARE CORP
Practice address
1716 W Horizon Ridge Pkwy Ste 130
Henderson, NV 89012-5003
Phone
(702) 209-6339
NPI assigned
Sep 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Authorized official

Name
Jessica Poole
Title
Credentialing Specialist
Phone
(702) 278-3919

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1716 W Horizon Ridge Pkwy Ste 130
Henderson, NV 89012-5003

Mailing address

8923 La Manga Ave
Las Vegas, NV 89147-6022
Phone (702) 209-6339

National Provider Directory

National Provider Directory

Locations

1716 W Horizon Ridge Pkwy
Ste 130
Henderson, NV 89012
Phone (702) 209-6339

Practitioners & affiliated clinicians

Practitioners 1

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": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1366058067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8923 LA MANGA AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891476022",
            "telephone_number": "702-209-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 W HORIZON RIDGE PKWY STE 130",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890125003",
            "telephone_number": "702-209-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAM CARE CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "702-278-3919"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; 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.