MEDICARE: SELF SUFFICIENCY BEHAVIORAL HEALTH 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

General Provider Information

NPI Number	:	1629556261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF SUFFICIENCY BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	3965 E OWENS AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-7034
Country	:	US
Telephone Number	:	702-331-5983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3965 E OWENS AVE STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-7034
Country	:	US
Telephone Number	:	702-331-5983
Fax Number	:	702-268-7848

Authorized Official
Title or Position	:	OWNER/QMHA
Name	:	CLAUDIA LIZBETH ORTIZ CRUZ
Credential	:	MSW
Telephone Number	:	702-704-9465

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	04/27/2021

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