MEDICARE: VALLEY PSYCHIATRIC SERVICES

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1285357905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 1303
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-1303
Country	:	US
Telephone Number	:	909-894-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 E WARM SPRINGS RD STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4282
Country	:	US
Telephone Number	:	909-894-4846
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	LIBERTY MACIAS
Credential	:	DNP
Telephone Number	:	909-894-4846

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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