P.R.I.D.E. Services L.L.C.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

NV20141081108 Issued in NV

Legal business name

P.R.I.D.E. SERVICES L.L.C.

Doing business as

Life Changers
Life Changers Behavioral Health and Supportive Services

Practice address

1516 E Tropicana Ave Ste 154
Las Vegas, NV 89119-8316

Phone

(702) 268-8109

NPI assigned

Mar 27, 2014

Organization subpart

No

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

Authorized official

Name

Andrea Denise Walker-DavisNPI 1871836007

Title

Manager

Phone

(702) 268-8109

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Life Changers Doing business as
• Life Changers Behavioral Health and Supportive Services Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea Denise Walker-Davis

  • Rehabilitation Practitioner
  • Las Vegas, NV
  • NPI 1871836007
  NPD Authorized official

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

{
    "created_epoch": "1395878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1407273360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 E TROPICANA AVE STE 154",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891198316",
            "telephone_number": "702-268-8109",
            "fax_number": "702-268-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 E TROPICANA AVE STE 154",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891198316",
            "telephone_number": "702-268-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.R.I.D.E. SERVICES L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-27",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "WALKER-DAVIS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-268-8109"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NV",
            "license": "NV20141081108",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407273360",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lifechangersbh@servicingwithpride.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1516 E Tropicana Ave Ste 154",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891198316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Life Changers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Changers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Changers Behavioral Health and Supportive Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cognitive & Behavioral Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Cognitive & Behavioral Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.