MEDICARE: KEEP THE FAITH BEHAVIORAL HEALTH LLC

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	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency	NV20171142637	NV

General Provider Information

NPI Number	:	1164962908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEEP THE FAITH BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4520 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5937
Country	:	US
Telephone Number	:	678-600-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5937
Country	:	US
Telephone Number	:	702-685-9220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA DENISE HURST
Credential	:
Telephone Number	:	678-600-3717

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	01/08/2018

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