MEDICARE: MS. FLO'S MENTAL HEALTH 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	NV20171271300	NV

General Provider Information

NPI Number	:	1316472277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS. FLO'S MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2920 S JONES BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5642
Country	:	US
Telephone Number	:	702-381-6525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 S JONES BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5642
Country	:	US
Telephone Number	:	702-381-6525
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIKO BAKER
Credential	:	N/A
Telephone Number	:	702-502-4045

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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