MEDICARE: LAS VEGAS BEHAVIORAL HEALTH

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	C20121018-1968	NV

General Provider Information

NPI Number	:	1750634432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2486 EL PASEO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2486 EL PASEO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4009
Country	:	US
Telephone Number	:	702-812-1405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIK GREEN
Credential	:
Telephone Number	:	702-812-1405

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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