MEDICARE: TARAMAR MENTAL HEALTH 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	261QH0100X	Health Service Clinic/Center	NV20141233364	NV

General Provider Information

NPI Number	:	1326458027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARAMAR MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	4009 SAN DIEGO ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 SAN DIEGO ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2809
Country	:	US
Telephone Number	:	702-467-5403
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MARELYN SHAPIRO
Credential	:
Telephone Number	:	702-467-5403

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	05/02/2014

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