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NPI Code Detail

MEDICARE: MOVING FORWARD BEHAVIORAL HEALTH LLC

MEDICARE: MOVING FORWARD BEHAVIORAL HEALTH 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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-21-47773OTHERNVBCBA

General Provider Information

NPI Number : 1366167207
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOVING FORWARD BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 10585 MEDICINE BOW ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-4906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10585 MEDICINE BOW ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-4906
Country : US
Telephone Number : 757-672-4174
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : LALEH BEIJAN
Credential : BCBA
Telephone Number : 757-672-4174
Provider Enumeration Date : 10/04/2022
Last Update Date : 10/04/2022

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Directions to “MOVING FORWARD BEHAVIORAL HEALTH LLC ” Practice Location

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