MEDICARE: MOTIVATION 4 CHANGE FAMILY SERVICES

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	:	1588902167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATION 4 CHANGE FAMILY SERVICES

Provider Business Mailing Address
First Line	:	4550 W OAKEY BLVD
Second Line	:	STE 97
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W OAKEY BLVD
Second Line	:	STE 97
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1581
Country	:	US
Telephone Number	:	702-719-9074
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOWIE FUIMAONO
Credential	:
Telephone Number	:	702-719-9074

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/16/2013

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Directions to “MOTIVATION 4 CHANGE FAMILY SERVICES ” Practice Location

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