MEDICARE: TALON PEAK YOUTH AND FAMILY COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033347745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALON PEAK YOUTH AND FAMILY COUNSELING

Provider Business Mailing Address
First Line	:	4612 EVAN RIDGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1624
Country	:	US
Telephone Number	:	702-375-1488
Fax Number	:	702-396-4193

Provider Business Practice Location Address
First Line	:	7381 PRAIRIE FALCON RD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0811
Country	:	US
Telephone Number	:	702-375-1488
Fax Number	:	702-396-4193

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	RAY TIPPETTS
Credential	:
Telephone Number	:	702-375-1488

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	07/02/2009

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