MEDICARE: NEW HORIZONS PSYCHIATRIC SERVICES MATHISEN PLLC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1346977022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZONS PSYCHIATRIC SERVICES MATHISEN PLLC

Provider Business Mailing Address
First Line	:	7361 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1576
Country	:	US
Telephone Number	:	702-545-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1576
Country	:	US
Telephone Number	:	702-545-0229
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL MATHISEN
Credential	:
Telephone Number	:	702-545-0229

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	09/01/2022

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