MEDICARE: IT'S OK 2 B DIFFERENT

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	:	1922494830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IT'S OK 2 B DIFFERENT

Provider Business Mailing Address
First Line	:	2007 RAIN STORM CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4857
Country	:	US
Telephone Number	:	702-980-9050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 RAIN STORM CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4857
Country	:	US
Telephone Number	:	702-980-9050
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MRS. TINA RANE BURSE
Credential	:
Telephone Number	:	702-980-9050

Provider Enumeration Date	:	04/08/2015
Last Update Date	:	08/16/2016

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