MEDICARE: THE PSYCH NETWORK

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		NV

General Provider Information

NPI Number	:	1295279131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PSYCH NETWORK

Provider Business Mailing Address
First Line	:	3085 E FLAMINGO RD
Second Line	:	SUITE B-1
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4308
Country	:	US
Telephone Number	:	702-457-3792
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 E FLAMINGO RD
Second Line	:	SUITE B-1
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4308
Country	:	US
Telephone Number	:	702-457-3792
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEBORAH ORNELAS
Credential	:
Telephone Number	:	702-547-3792

Provider Enumeration Date	:	12/12/2016
Last Update Date	:	12/12/2016

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Directions to “THE PSYCH NETWORK ” Practice Location

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