MEDICARE: CORPORATE BEHAVIORAL PARTNERS, LLC

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	1041C0700X	Clinical Social Worker	2524-C	NV

General Provider Information

NPI Number	:	1336442987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORPORATE BEHAVIORAL PARTNERS, LLC

Provider Business Mailing Address
First Line	:	8565 S EASTERN AVE STE 178
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2907
Country	:	US
Telephone Number	:	702-271-5957
Fax Number	:	702-294-2866

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 178
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2907
Country	:	US
Telephone Number	:	702-271-5957
Fax Number	:	702-294-2866

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. BRENT M REYNOLDS
Credential	:	MSW, LCSW
Telephone Number	:	702-271-5957

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	02/25/2015

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