MEDICARE: SOUTHERN NEVADA FAMILY SERVICES LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1992463517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN NEVADA FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	6935 ALIANTE PKWY STE 104
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-5819
Country	:	US
Telephone Number	:	702-273-9890
Fax Number	:

Provider Business Practice Location Address
First Line	:	6935 ALIANTE PKWY STE 104
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-5819
Country	:	US
Telephone Number	:	702-273-9890
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MRS. JESSICA CARR
Credential	:
Telephone Number	:	702-273-9890

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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