MEDICARE: SOUTHERN NEVADA BEHAVIORAL HEALTH NETWORK

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497031223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA BEHAVIORAL HEALTH NETWORK

Provider Business Mailing Address
First Line	:	1100 MERIDIAN BAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1625
Country	:	US
Telephone Number	:	702-719-9773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 MERIDIAN BAY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1625
Country	:	US
Telephone Number	:	702-719-9773
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	MS. MONIQUE HARRIS
Credential	:	LSW
Telephone Number	:	702-719-9773

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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