MEDICARE: EFFECTIVE BELIEFS 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	207Q00000X	Family Medicine Physician
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1770263659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EFFECTIVE BELIEFS BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	8275 S EASTERN AVE STE 247
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2505
Country	:	US
Telephone Number	:	435-229-3245
Fax Number	:

Provider Business Practice Location Address
First Line	:	8275 S EASTERN AVE STE 247
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2505
Country	:	US
Telephone Number	:	435-229-3245
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GUSTAVO MEDINA
Credential	:
Telephone Number	:	435-229-3234

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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