MEDICARE: TRUE HEARTS CARE QUALITY BEHAVIORAL SERVICE

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	103TH0100X	Health Service Psychologist

General Provider Information

NPI Number	:	1225546351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE HEARTS CARE QUALITY BEHAVIORAL SERVICE

Provider Business Mailing Address
First Line	:	5415 W HARMON AVE UNIT 2193
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7049
Country	:	US
Telephone Number	:	702-801-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 W HARMON AVE UNIT 2193
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7049
Country	:	US
Telephone Number	:	702-801-9180
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMANDA HAMPTON
Credential	:
Telephone Number	:	702-801-9181

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	01/10/2018

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