MEDICARE: NEVADA PRIME CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	103TC0700X	Clinical Psychologist
4	1041C0700X	Clinical Social Worker
5	106H00000X	Marriage & Family Therapist
6	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1972112373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVADA PRIME CARE LLC

Provider Business Mailing Address
First Line	:	3340 TOPAZ ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3903
Country	:	US
Telephone Number	:	702-588-1938
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 TOPAZ ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3903
Country	:	US
Telephone Number	:	702-588-1938
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ARIAGNE ARIELLE DUAVE
Credential	:
Telephone Number	:	702-588-1938

Provider Enumeration Date	:	07/31/2020
Last Update Date	:	06/09/2021

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Directions to “NEVADA PRIME CARE LLC ” Practice Location

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