MEDICARE: VIP BEHAVIORAL HEALTH SUPPORT SERVICES

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	:	1639615784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP BEHAVIORAL HEALTH SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	2613 ALMA LIDIA AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0728
Country	:	US
Telephone Number	:	702-504-3767
Fax Number	:

Provider Business Practice Location Address
First Line	:	2613 ALMA LIDIA AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0728
Country	:	US
Telephone Number	:	702-504-3767
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BARBARA HOUSTON
Credential	:
Telephone Number	:	702-504-3767

Provider Enumeration Date	:	01/12/2017
Last Update Date	:	01/12/2017

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