MEDICARE: SOUTHWEST BEHAVIORAL HEALTH SERVICES

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)

General Provider Information

NPI Number	:	1013422666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 311
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5067
Country	:	US
Telephone Number	:	702-771-0304
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 311
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5067
Country	:	US
Telephone Number	:	702-771-0304
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLIFFORD ETIENNE
Credential	:
Telephone Number	:	702-771-0304

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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