MEDICARE: DESIRED RESULTS BEHAVIORAL HEALTH CENTER

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	103K00000X	Behavior Analyst		NV

General Provider Information

NPI Number	:	1285077917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESIRED RESULTS BEHAVIORAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	2108 REVERE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4048
Country	:	US
Telephone Number	:	702-648-5430
Fax Number	:	702-648-5429

Provider Business Practice Location Address
First Line	:	2108 REVERE ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4048
Country	:	US
Telephone Number	:	702-648-5430
Fax Number	:	702-648-5429

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CAMELLIA WILLIAMS
Credential	:
Telephone Number	:	702-648-5430

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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