Healthcare Provider Details

I. General information

NPI: 1821707241
Provider Name (Legal Business Name): BEHAVIORAL AND MENTAL MATTERS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 N MARTIN LUTHER KING BLVD STE A
NORTH LAS VEGAS NV
89032-0299
US

IV. Provider business mailing address

4130 N MARTIN LUTHER KING BLVD STE A
NORTH LAS VEGAS NV
89032-0299
US

V. Phone/Fax

Practice location:
  • Phone: 702-764-4868
  • Fax:
Mailing address:
  • Phone: 702-764-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NENETH M SUAREZ
Title or Position: PRESIDENT
Credential:
Phone: 702-764-4868