MEDICARE: DIAMOND MENTAL HEALTH

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	#1039	NV

General Provider Information

NPI Number	:	1255767034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAMOND MENTAL HEALTH

Provider Business Mailing Address
First Line	:	3622 N RANCHO DR STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3161
Country	:	US
Telephone Number	:	702-395-4002
Fax Number	:	702-395-4003

Provider Business Practice Location Address
First Line	:	3622 N RANCHO DR STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3161
Country	:	US
Telephone Number	:	702-395-4002
Fax Number	:	702-395-4003

Authorized Official
Title or Position	:	CEO
Name	:	CONSTANCE KNIGHT
Credential	:
Telephone Number	:	702-395-4002

Provider Enumeration Date	:	09/24/2013
Last Update Date	:	09/24/2013

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