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2235 E Flamingo Rd Ste 234 Las Vegas NV 89119-5197 | |
| (702) 331-5608 | |
| (702) 463-0996 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2235 E Flamingo Rd Ste 234, Las Vegas, Nevada |
| Authorized Official Name and Position | Bryan Link (EXECUTIVE DIR/QMHP) |
| Authorized Official Contact | 7023315608 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2235 E Flamingo Rd Ste 234 Las Vegas NV 89119-5197 Ph: (702) 331-5608 | 2235 E Flamingo Rd Ste 234 Las Vegas NV 89119-5197 Ph: (702) 331-5608 |
| NPI Number | 1649529983 |
|---|---|
| Provider Enumeration Date | 08/31/2012 |
| Last Update Date | 05/26/2017 |
| Medicare PECOS PAC ID | 1557585114 |
|---|---|
| Medicare Enrollment ID | O20140702001582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649529983 | NPI | - | NPPES |
| 1467634352 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6422-C (Nevada) | Secondary |
| 251S00000X | Community/behavioral Health | IC675 (Nevada) | Primary |
| Provider Name | Bryan Link |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467634352 PECOS PAC ID: 8820213085 Enrollment ID: I20140701001352 |
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