MEDICARE: CSSI BEHAVIORAL HEALTH 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	1041C0700X	Clinical Social Worker
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659666170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CSSI BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3620 N RANCHO DR STE 111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3154
Country	:	US
Telephone Number	:	702-639-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N RANCHO DR STE 111
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3154
Country	:	US
Telephone Number	:	702-639-4405
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHYLLIS TELLIS
Credential	:
Telephone Number	:	702-639-4405

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	08/29/2016

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