MEDICARE: NEVADA BEHAVIORAL CARE, INC

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	1041C0700X	Clinical Social Worker	6129-C	NV

General Provider Information

NPI Number	:	1053749721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA BEHAVIORAL CARE, INC

Provider Business Mailing Address
First Line	:	2525 N. DECATUR, ST 2/3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	702-449-4669
Fax Number	:	702-629-6060

Provider Business Practice Location Address
First Line	:	2525 N. DECATUR, ST 2/3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	702-449-4669
Fax Number	:	702-629-6060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. TERRI J. BROOKS
Credential	:
Telephone Number	:	702-449-6649

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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