MEDICARE: PIVOT BEHAVIORAL HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1396430682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIVOT BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1771 E FLAMINGO RD STE 200A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0838
Country	:	US
Telephone Number	:	702-527-2571
Fax Number	:

Provider Business Practice Location Address
First Line	:	1771 E FLAMINGO RD STE 200A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0838
Country	:	US
Telephone Number	:	702-527-2571
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JENNIFER LYNN WOODALL
Credential	:	LCSW
Telephone Number	:	702-604-7767

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	03/06/2025

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