MEDICARE: MENDED

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	104100000X	Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1629601026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDED

Provider Business Mailing Address
First Line	:	6720 N HUALAPAI WAY STE 145-255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1371
Country	:	US
Telephone Number	:	702-551-9380
Fax Number	:

Provider Business Practice Location Address
First Line	:	6797 CONQUISTADOR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1315
Country	:	US
Telephone Number	:	702-551-9380
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	KELLI MOSLEY
Credential	:	LMFT
Telephone Number	:	702-551-9380

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	02/14/2020

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Directions to “MENDED ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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