MEDICARE: YOUR CHOICE BEHAVIOR

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801176839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CHOICE BEHAVIOR

Provider Business Mailing Address
First Line	:	3785 E SUNSET RD # A-10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6259
Country	:	US
Telephone Number	:	702-985-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	3785 E SUNSET RD # A-10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6259
Country	:	US
Telephone Number	:	702-985-2345
Fax Number	:

Authorized Official
Title or Position	:	OWNERADMINISTRATOR DIRECTOR
Name	:	MR. LARRY CLARKE
Credential	:
Telephone Number	:	702-985-2345

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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Directions to “YOUR CHOICE BEHAVIOR ” Practice Location

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