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NPI Code Detail

MEDICARE: M.C.A ENTERPRISES PROFESSIONAL LLC

MEDICARE: M.C.A ENTERPRISES PROFESSIONAL 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103K00000XBehavior Analyst
3103TB0200XCognitive & Behavioral Psychologist
4103TH0100XHealth Service Psychologist
5163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse
6163WP0808XPsychiatric/Mental Health Registered Nurse
7172V00000XCommunity Health Worker
8251B00000XCase Management Agency
9251E00000XHome Health Agency
10320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
11251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1417752635
Entity Type Code : Organization
Provider Name (Legal Business Name) : M.C.A ENTERPRISES PROFESSIONAL LLC
Provider Business Mailing Address
First Line : 7495 W AZURE DR STE 256
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-4417
Country : US
Telephone Number : 702-403-7997
Fax Number :
Provider Business Practice Location Address
First Line : 7495 W AZURE DR STE 256
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-4417
Country : US
Telephone Number : 702-403-7997
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : AUDREENA HARRIS
Credential :
Telephone Number : 702-403-7997
Provider Enumeration Date : 02/13/2025
Last Update Date : 02/13/2025

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