MEDICARE: BREAKING THE CYCLE BEHAVIORAL HEALTH SERVICES INC.

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

General Provider Information

NPI Number	:	1073870598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKING THE CYCLE BEHAVIORAL HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	2475 W CHEYENNE AVE
Second Line	:	SUITE 170
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4327
Country	:	US
Telephone Number	:	702-808-8641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2475 W CHEYENNE AVE
Second Line	:	SUITE 170
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4327
Country	:	US
Telephone Number	:	702-808-8641
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOULANDA JOHNSON
Credential	:
Telephone Number	:	702-808-8641

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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