Provider Demographics
NPI:1215221866
Name:MOBILE MENTALHEALTH SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:MOBILE MENTALHEALTH SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:JAMITO
Authorized Official - Last Name:PRIANES
Authorized Official - Suffix:
Authorized Official - Credentials:DIPLOMA
Authorized Official - Phone:818-641-9856
Mailing Address - Street 1:406 S 11TH ST
Mailing Address - Street 2:APT 9
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7128
Mailing Address - Country:US
Mailing Address - Phone:818-641-9856
Mailing Address - Fax:
Practice Address - Street 1:406 S 11TH ST
Practice Address - Street 2:APT 9
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-7128
Practice Address - Country:US
Practice Address - Phone:818-641-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01524843251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health