MEDICARE: MEDICAL AND BEHAVIORAL HEALTH CENTER 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	261QM0850X	Adult Mental Health Clinic/Center
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1346938255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL AND BEHAVIORAL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	1363 W OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2432
Country	:	US
Telephone Number	:	725-204-0953
Fax Number	:

Provider Business Practice Location Address
First Line	:	1363 W OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2432
Country	:	US
Telephone Number	:	725-204-0953
Fax Number	:

Authorized Official
Title or Position	:	REPRESENTATIVE
Name	:	EMILIE PALABASAN
Credential	:
Telephone Number	:	225-371-1230

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	04/27/2023

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