MEDICARE: KP BEHAVIORAL HEALTH SOLUTIONS

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	:	1568148435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KP BEHAVIORAL HEALTH SOLUTIONS

Provider Business Mailing Address
First Line	:	6614 BLUE DIAMOND RD UNIT 1240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139
Country	:	US
Telephone Number	:	702-689-0353
Fax Number	:

Provider Business Practice Location Address
First Line	:	6614 BLUE DIAMOND RD UNIT 1240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139
Country	:	US
Telephone Number	:	702-689-0353
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PRECIOUS OLISADUM
Credential	:
Telephone Number	:	702-689-0353

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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