MEDICARE: UNBROKEN HEALING INSIDE OUT

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	:	1245506765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNBROKEN HEALING INSIDE OUT

Provider Business Mailing Address
First Line	:	7336 RIBBON RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4405
Country	:	US
Telephone Number	:	702-686-6782
Fax Number	:

Provider Business Practice Location Address
First Line	:	7336 RIBBON RIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4405
Country	:	US
Telephone Number	:	702-686-6782
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LYNN BROOKS
Credential	:
Telephone Number	:	702-686-6782

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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Directions to “UNBROKEN HEALING INSIDE OUT ” Practice Location

Language	Start Address	Practice Location

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