MEDICARE: MYMS CORPORATION

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center	CI-0010	NV
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center	CI-0010	NV
4	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1588969737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYMS CORPORATION

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE
Second Line	:	SUITE 310
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-860-8573
Fax Number	:	702-562-8133

Provider Business Practice Location Address
First Line	:	9550 S EASTERN AVE
Second Line	:	SUITE 253
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8038
Country	:	US
Telephone Number	:	702-860-8573
Fax Number	:	702-562-8133

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KIMBERLY GIBSON
Credential	:	CPC-INTERN
Telephone Number	:	702-860-8573

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	01/19/2011

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Directions to “MYMS CORPORATION ” Practice Location

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