MEDICARE: MENTAL HEALTH COUNSELING AND CONSULTING 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1497363386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL HEALTH COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	2218 SUMMERWIND CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2321
Country	:	US
Telephone Number	:	310-890-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 178
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2907
Country	:	US
Telephone Number	:	310-890-0599
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR, OWNER
Name	:	DR. RORY REID
Credential	:	PH.D., LCSW
Telephone Number	:	310-890-0599

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	07/17/2020

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