OrganizationActive
Community Youth Interalia
NPI 1790282002 · Exercise & Sports Psychologist · Las Vegas, NV
Provider details
- NPI number
- 1790282002
- Entity type
- Organization
- Primary specialty
- Exercise & Sports PsychologistBehavioral Health & Social Service Providers
- Parent organization
- Community Youth Interalia
- Authorized official
- Jude Niba, President
- License
- 667 (NV)
Practice location
9082 Vintage Wine Ave
Las Vegas, NV 89148-4916
Phone: (702) 328-0459
Mailing address
9082 Vintage Wine Ave
Las Vegas, NV 89148-4916
Registry dates
- Enumerated
- 2018-04-12
- Last updated
- 2018-04-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.