MEDICARE: COUCH PSYCHIATRY, PC

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	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1053161257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUCH PSYCHIATRY, PC

Provider Business Mailing Address
First Line	:	901 FREMONT ST APT 374
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-5439
Country	:	US
Telephone Number	:	792-280-6805
Fax Number	:	415-696-1090

Provider Business Practice Location Address
First Line	:	6330 W FLAMINGO RD UNIT 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2234
Country	:	US
Telephone Number	:	702-280-6805
Fax Number	:	415-696-1090

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH NAYLOR KENAN
Credential	:	MD
Telephone Number	:	702-270-6805

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	05/09/2024

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Directions to “COUCH PSYCHIATRY, PC ” Practice Location

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