MEDICARE: SML MENTAL HEALTH SERVICES, 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

General Provider Information

NPI Number	:	1326632266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SML MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2496 RIVER OAKS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-4905
Country	:	US
Telephone Number	:	702-981-0289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2496 RIVER OAKS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-4905
Country	:	US
Telephone Number	:	702-981-0289
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LUCIA MATTHEW
Credential	:
Telephone Number	:	702-981-0289

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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