Provider Demographics
NPI:1700495884
Name:FMT BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FMT BEHAVIORAL HEALTH SERVICES
Other - Org Name:OSEREMEN BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCISCA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-789-8038
Mailing Address - Street 1:1012 BISTRO BAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1337
Mailing Address - Country:US
Mailing Address - Phone:702-789-8038
Mailing Address - Fax:702-436-5615
Practice Address - Street 1:4170 S DECATUR BLVD STE A6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5862
Practice Address - Country:US
Practice Address - Phone:702-789-8038
Practice Address - Fax:702-436-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)