MEDICARE: NEVADA NEUROFEEDBACK AND HYPNOSIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	347C00000X	Private Vehicle
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1487121190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA NEUROFEEDBACK AND HYPNOSIS LLC

Provider Business Mailing Address
First Line	:	6895 E. LAKE MEAD BLVD
Second Line	:	SUITE 6 #200
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-6767
Country	:	US
Telephone Number	:	702-329-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 S MARYLAND PKWY STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3225
Country	:	US
Telephone Number	:	702-329-4262
Fax Number	:	702-825-0015

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. LOUIS M HAYNIE
Credential	:	LCSW
Telephone Number	:	702-329-4262

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	08/09/2021

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