MEDICARE: MYRIAD BEHAVIORAL SOLUTIONS, INC.

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	103TC0700X	Clinical Psychologist
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1366854754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRIAD BEHAVIORAL SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	4100 NEWPORT PLACE DR
Second Line	:	SUITE 730
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 NEWPORT PLACE DR
Second Line	:	SUITE 730
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2423
Country	:	US
Telephone Number	:	949-612-3955
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NISHANT KUMAR
Credential	:	D.O.
Telephone Number	:	949-612-3955

Provider Enumeration Date	:	05/20/2014
Last Update Date	:	05/20/2014

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