Provider Demographics
NPI:1023721065
Name:MEDICAL AND BEHAVIORAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:MEDICAL AND BEHAVIORAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALABASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-371-1230
Mailing Address - Street 1:1363 W OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2432
Mailing Address - Country:US
Mailing Address - Phone:725-204-0953
Mailing Address - Fax:702-552-0302
Practice Address - Street 1:4225 S EASTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5485
Practice Address - Country:US
Practice Address - Phone:725-204-0953
Practice Address - Fax:702-552-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder