Look up the most recent NPI and PECOS records

1111 Therapy & Mental Health Institute

Counselor

Behavioral Health & Social Service Providers

1504 Blackcombe St Unit 204, Las Vegas, NV 89128-8019

PECOS Enrollment

Based on the most recent information from CMS, provider 1111 Therapy & Mental Health Institute does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1831863315
Provider Type
Organization
Full Name
1111 Therapy & Mental Health Institute

Subpart
No
Enumeration Date
8/6/2021
Last Updated
8/6/2021

Contact Information

Practice Location

1504 Blackcombe St Unit 204, Las Vegas, NV 89128-8019

(404) 849-9918

Unlisted Fax

Mailing Location

1504 Blackcombe St Unit 204, Las Vegas, NV 89128-8019

(404) 849-9918

Unlisted Fax

Authorized Official

Bumpers, Rodney (Manager)

(404) 849-9918

Provider Taxonomies

Code	Description	License
Code 101YM0800X Primary	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 101200000X	Description	License Unlisted Issuer
Code 101Y00000X	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 101YA0400X	Description Counselor Behavioral Health & Social Service Providers	License Unlisted Issuer
Code 2084P0015X	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 221700000X	Description Art Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer
Code 225400000X	Description Rehabilitation Practitioner Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer
Code 225600000X	Description Dance Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer
Code 225A00000X	Description Music Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer
Code 225C00000X	Description Rehabilitation Counselor Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer
Code 251B00000X	Description Case Management Agencies	License Unlisted Issuer
Code 251S00000X	Description Community/Behavioral Health Agencies	License Unlisted Issuer
Code 3104A0630X	Description Assisted Living Facility Nursing & Custodial Care Facilities	License Unlisted Issuer
Code 320800000X	Description Community Based Residential Treatment Facility, Mental Illness Residential Treatment Facilities	License Unlisted Issuer
Code 320900000X	Description Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 1245755636	Description Medicaid	Issuer Unlisted Nevada
ID 1821367087	Description Medicaid	Issuer Unlisted Nevada

1111 Therapy & Mental Health Institute

PECOS Enrollment

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