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General NPI Number Information
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NPI Number | 1215221866
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Entity Type | Organization
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Legal Business Name | MOBILE MENTALHEALTH SUPPORT SERVICES, INC.
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 406 S 11TH ST APT 9
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City | LAS VEGAS
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State | NV
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Zip | 89101-7128
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Country | US
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Telephone | 818-641-9856
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Fax |
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Provider Business Mailing Address
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Address Line | 406 S 11TH ST APT 9
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City | LAS VEGAS
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State | NV
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Zip | 89101-7128
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Country | US
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Telephone | 818-641-9856
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Fax |
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Authorized Official
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Title or Position | QBA
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Name | MRS. MILAGROS JAMITO PRIANES
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Credential | DIPLOMA
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Telephone | 818-641-9856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 01524843
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License Number State | NV
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