NPIMap

Organization Active NPI

1111 Therapy & Mental Health Institute

  • Mental Health Counselor
  • Las Vegas, NV
National Provider Identifier
1831863315
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
1111 THERAPY & MENTAL HEALTH INSTITUTE
Practice address
1504 Blackcombe St Unit 204
Las Vegas, NV 89128-8019
Phone
(404) 849-9918
NPI assigned
Aug 6, 2021
Last updated
Aug 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Authorized official

Name
Rodney Bumpers, M.EDNPI 1821367087
Title
Manager
Phone
(404) 849-9918

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU Primary
Art Therapist 221700000X NU
Rehabilitation Practitioner 225400000X NU
Dance Therapist 225600000X NU
Music Therapist 225A00000X NU
Rehabilitation Counselor 225C00000X NU
Case Management Agency 251B00000X NU
Assisted Living Facility (Behavioral Disturbances) 3104A0630X NU
Mental Illness Community Based Residential Treatment Facility 320800000X NU
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X NU
Community/Behavioral Health Agency 251S00000X NU
Psychosomatic Medicine Physician 2084P0015X NU
Drama Therapist 101200000X NU

Addresses

Primary practice location

1504 Blackcombe St Unit 204
Las Vegas, NV 89128-8019

Mailing address

1504 Blackcombe St Unit 204
Las Vegas, NV 89128-8019
Phone (404) 849-9918

Other identifiers 2

IdentifierTypeStateIssuer
1821367087MedicaidNV
1245755636MedicaidNV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1831863315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 BLACKCOMBE ST UNIT 204",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891288019",
            "telephone_number": "404-849-9918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 BLACKCOMBE ST UNIT 204",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891288019",
            "telephone_number": "404-849-9918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1111 THERAPY & MENTAL HEALTH INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "BUMPERS",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "404-849-9918",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225600000X",
            "taxonomy_group": "",
            "desc": "Dance Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225A00000X",
            "taxonomy_group": "",
            "desc": "Music Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0015X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychosomatic Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101200000X",
            "taxonomy_group": "",
            "desc": "Drama Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821367087",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245755636",
            "state": "NV"
        }
    ],
    "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 Aug 6, 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.