MEDICARE: EXODUS FAMILY & GUIDANCE COALITION, 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
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811310584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXODUS FAMILY & GUIDANCE COALITION, LLC

Provider Business Mailing Address
First Line	:	9110 W LONE MOUNTAIN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-3563
Country	:	US
Telephone Number	:	702-466-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3311
Country	:	US
Telephone Number	:	702-466-4360
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAREN DELCINA LEE
Credential	:	ED.D.
Telephone Number	:	702-466-4360

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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