MEDICARE: MOBILE CRISIS UNIT PROFESSIONAL CORPORATION

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	:	1275311789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE CRISIS UNIT PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2340 PASEO DEL PRADO STE D303
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4342
Country	:	US
Telephone Number	:	702-419-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 S FLOWER ST # 1848
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90071-2201
Country	:	US
Telephone Number	:	702-419-0595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAREN L CRUEY
Credential	:	MD
Telephone Number	:	702-419-0595

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	08/30/2024

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