MEDICARE: SUPPORTIVE COUNSELING 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	251S00000X	Community/Behavioral Health Agency	NV20131579025	NV

General Provider Information

NPI Number	:	1508294737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORTIVE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	284 SOGGY RUFF WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148
Country	:	US
Telephone Number	:	702-513-8186
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 W CHARLESTON BLVD
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9073
Country	:	US
Telephone Number	:	702-513-8186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAY POSADAS
Credential	:
Telephone Number	:	702-513-8186

Provider Enumeration Date	:	10/25/2013
Last Update Date	:	11/06/2013

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