Community Youth Interalia

Primary specialty

Exercise & Sports PsychologistTaxonomy code 103TE1100X

License

667 Issued in NV

Legal business name

COMMUNITY YOUTH INTERALIA

Practice address

9082 Vintage Wine Ave
Las Vegas, NV 89148-4916

Phone

(702) 328-0459

NPI assigned

Apr 12, 2018

Organization subpart

Yes

Parent organization

COMMUNITY YOUTH INTERALIAAs reported in NPPES

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

Authorized official

Name

Jude Niba, ED.D CMPC-AASPNPI 1821586512

Title

President

Phone

(702) 328-0459

Specialties & licenses 1

Addresses

Other names 1

• Seao Interalia Doing business as

Tax ID family

Seao Interalia2 organizations share this tax ID, including this one

Part of

Seao Interalia

Other organizations with this tax ID 1

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

• Seao Interalia

  • Non-emergency Medical Transport (VAN)
  • Las Vegas, NV
  • NPI 1871055947
  NPD tax ID

Practitioners 1

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

• Jude Niba

  • Exercise & Sports Psychologist
  • Las Vegas, NV
  • NPI 1821586512
  NPD (past) Authorized official

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

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1790282002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9082 VINTAGE WINE AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484916",
            "telephone_number": "702-328-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9082 VINTAGE WINE AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891484916",
            "telephone_number": "702-328-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY YOUTH INTERALIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY YOUTH INTERALIA",
        "enumeration_date": "2018-04-12",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "NIBA",
        "authorized_official_first_name": "JUDE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-328-0459",
        "authorized_official_credential": "ED.D CMPC-AASP"
    },
    "taxonomies": [
        {
            "code": "103TE1100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Exercise & Sports",
            "state": "NV",
            "license": "667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seao Interalia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community of One Behavior Health
• Community Outreach Medical Center
• Community Outreach Medical Center
• Community Porchlight LLC
• Community Smiles Initiative
• Wilda Bugnay Comocho
• Ashley Nicole Compagnoni, B.A.
• Companion Care LLC
• Companion Care Support Services
• Companion Care Support Services

• Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.