NPIMap

Organization Active NPI

Boys Town Nevada, Inc.

  • Psychologist
  • Las Vegas, NV
National Provider Identifier
1457806663
Registry record updated May 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
BOYS TOWN NEVADA, INC.
Practice address
6460 Medical Center St Ste 140
Las Vegas, NV 89148-2420
Phone
(702) 642-7070
Fax
(702) 649-3906
NPI assigned
Aug 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2026

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

Authorized official

Name
John Etzell
Title
Executive Director
Phone
(702) 642-7070

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

6460 Medical Center St Ste 140
Las Vegas, NV 89148-2420

Mailing address

8390 W Windmill LN Ste 102&103
Las Vegas, NV 89113-4420
Phone (702) 888-1340

National Provider Directory

National Provider Directory
Tax ID family
Boys Town Nevada Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6460 Medical Center St
Ste 140
Las Vegas, NV 89148
Phone (702) 888-1340

Practitioners & affiliated clinicians

Practitioners 11

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": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778716800000",
    "number": "1457806663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8390 W WINDMILL LN STE 102&103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891134420",
            "telephone_number": "702-888-1340",
            "fax_number": "702-888-1342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 MEDICAL CENTER ST STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482420",
            "telephone_number": "702-642-7070",
            "fax_number": "702-649-3906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS TOWN NEVADA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2026-05-14",
        "certification_date": "2026-05-14",
        "status": "A",
        "authorized_official_last_name": "ETZELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "702-642-7070"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 May 14, 2026; 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.