MEDICARE: SOUTHERN NEVADA BEHAVIORAL HEALTH AUTHORITY 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	:	1770960874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA BEHAVIORAL HEALTH AUTHORITY LLC

Provider Business Mailing Address
First Line	:	6883 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1645
Country	:	US
Telephone Number	:	702-586-3050
Fax Number	:	702-586-3062

Provider Business Practice Location Address
First Line	:	6857 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	702-586-3050
Fax Number	:	702-586-3062

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MITRIECE AMELIA SUMBRY
Credential	:	QMHA
Telephone Number	:	702-586-3050

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	07/21/2022

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