MEDICARE: MUSTARD SEED COUNSELING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1912857756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSTARD SEED COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	1545 MELODIC LARK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 MELODIC LARK DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-6586
Country	:	US
Telephone Number	:	702-417-1366
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RASHEDA L ANDERSON
Credential	:	LCPC
Telephone Number	:	404-437-0596

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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