MEDICARE: PROSPERITY MENTAL HEALTH, 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	:	1255758918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPERITY MENTAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	1433 N JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1610
Country	:	US
Telephone Number	:	702-419-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 N JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1610
Country	:	US
Telephone Number	:	702-419-1222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID J OTTO
Credential	:	J.D.
Telephone Number	:	702-419-1222

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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