MEDICARE: BEHAVIORAL HEALTH SERVICES OF SOUTHERN NEVADA LLC

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

General Provider Information

NPI Number	:	1033578562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH SERVICES OF SOUTHERN NEVADA LLC

Provider Business Mailing Address
First Line	:	1771 E FLAMINGO RD
Second Line	:	SUITE #112B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5155
Country	:	US
Telephone Number	:	702-732-4357
Fax Number	:	702-732-4358

Provider Business Practice Location Address
First Line	:	1771 E FLAMINGO RD
Second Line	:	SUITE #112B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5155
Country	:	US
Telephone Number	:	702-732-4357
Fax Number	:	702-732-4358

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DARRY LEE LIGHTEN
Credential	:
Telephone Number	:	702-460-9266

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	08/03/2016

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