MEDICARE: LAS VEGAS MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist
3	171M00000X	Case Manager/Care Coordinator
4	251B00000X	Case Management Agency
5	261QM0850X	Adult Mental Health Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1124745930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	4935 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6402
Country	:	US
Telephone Number	:	702-483-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6402
Country	:	US
Telephone Number	:	702-483-8333
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSE L MIERA
Credential	:
Telephone Number	:	702-483-8333

Provider Enumeration Date	:	10/21/2022
Last Update Date	:	03/07/2023

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Directions to “LAS VEGAS MENTAL HEALTH SERVICES ” Practice Location

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