MEDICARE: A LINE MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	5124-C	NV

General Provider Information

NPI Number	:	1013289495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LINE MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3315 WILD FILLY LN
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2474
Country	:	US
Telephone Number	:	702-475-1666
Fax Number	:	702-778-4566

Provider Business Practice Location Address
First Line	:	3315 WILD FILLY LN
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2474
Country	:	US
Telephone Number	:	702-475-1666
Fax Number	:	702-778-4566

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. DONNA MARIE MCNEECE
Credential	:	LCSW
Telephone Number	:	702-778-4566

Provider Enumeration Date	:	02/01/2012
Last Update Date	:	02/01/2012

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