Good Medicine Ranch LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C10154 Issued in NV

Legal business name

GOOD MEDICINE RANCH LLC

Practice address

2400 N Tenaya Way
Las Vegas, NV 89128-0420

Phone

(702) 626-9400

NPI assigned

Apr 19, 2018

Last updated

Apr 19, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Holly A Davis, CPCINPI 1508264425

Title

Manager

Phone

(702) 626-9400

Specialties & licenses 1

Addresses

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.

• Holly Ann Davis, CPC-I

  • Professional Counselor
  • Las Vegas, NV
  • NPI 1508264425
  NPD Authorized official

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1932696499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4716 ANCHORAGE ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891475101",
            "telephone_number": "702-626-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 N TENAYA WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280420",
            "telephone_number": "702-626-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD MEDICINE RANCH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "702-626-9400",
        "authorized_official_credential": "CPCI"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NV",
            "license": "C10154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tatyana Gonzhurova
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• Good Life Therapy, LLC
• Good Sam LLC
• Good Samaritan Behavioral Health and Community Services (good samaritan crisis center)
• Good Samaritan Family Practice
• Good Samaritan Healthcare
• Good Samaritan Healthcare, LLC

• Professional Counselor in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Professional Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.