MEDICARE: CSSI BEHAVIORAL HEALTH SERVICES 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	171M00000X	Case Manager/Care Coordinator
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437534419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSSI BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3013 N RANCHO DR STE 127
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3013 N RANCHO DR STE 127
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3349
Country	:	US
Telephone Number	:	702-639-4405
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PHYLLIS TELLIS
Credential	:
Telephone Number	:	70526394405

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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