NPIMap

Organization Active NPI

Life Gateway

  • Clinical Child & Adolescent Psychologist
  • North Las Vegas, NV
National Provider Identifier
1710246921
Registry record updated May 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
LIFE GATEWAY
Practice address
2128 Pink Coral Dr
North Las Vegas, NV 89031-0985
Phone
(702) 234-9822
NPI assigned
May 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2012

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

Authorized official

Name
Cynthia Ewell
Title
Managing Member
Phone
(702) 752-9274

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X NV Primary

Addresses

Primary practice location

2128 Pink Coral Dr
North Las Vegas, NV 89031-0985

Mailing address

3605 Mountain Crest St
Las Vegas, NV 89129-7864

National Provider Directory

National Provider Directory
Tax ID family
Life Gateway5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336435200000",
    "number": "1710246921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 MOUNTAIN CREST ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891297864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2128 PINK CORAL DR",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890310985",
            "telephone_number": "702-234-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE GATEWAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-08",
        "last_updated": "2012-05-08",
        "status": "A",
        "authorized_official_last_name": "EWELL",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "702-752-9274"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North 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 8, 2012; 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.