MEDICARE: LDS FAMILY 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	4096-C	NV

General Provider Information

NPI Number	:	1790990349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDS FAMILY SERVICES

Provider Business Mailing Address
First Line	:	4455 ALLEN LN
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2229
Country	:	US
Telephone Number	:	702-385-1072
Fax Number	:	702-385-3053

Provider Business Practice Location Address
First Line	:	4455 ALLEN LN
Second Line	:	SUITE 130
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2229
Country	:	US
Telephone Number	:	702-385-1072
Fax Number	:	702-385-3053

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. RICK L PERRY
Credential	:	LCSW
Telephone Number	:	702-385-1072

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	06/06/2008

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1073728721 — RICKEY L PERRY MSW
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1043485527 — CARA MARIE HADLEY LSW
Practice Location Address:

4455 ALLEN LN , SUITE 130
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1376702555 — MRS. AMANDA DIANE HUGHES MS
Practice Location Address:

4455 ALLEN LN , SUITE 130
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1154551745 — AMY GENIEL EKINS LCSW-I
Practice Location Address:

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Practice Phone: 702-385-1072
Practice Fax: 702-385-3053

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