NPIMap

Organization Active NPI

Nueva Vida Mental Health LLC

Doing business as NVMH

  • Clinical Social Worker
  • Las Vegas, NV
National Provider Identifier
1598015240
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6215-C Issued in NV
Legal business name
NUEVA VIDA MENTAL HEALTH LLC
Doing business as
NVMH
Practice address
4170 S Decatur Blvd Ste C1
Las Vegas, NV 89103-5863
Phone
(702) 659-8827
Fax
(702) 852-0984
NPI assigned
Sep 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marysol RezanovNPI 1003127499
Title
Mental Health Therapist
Phone
(702) 659-8827

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 6215-C NV Primary

Addresses

Primary practice location

4170 S Decatur Blvd Ste C1
Las Vegas, NV 89103-5863

Mailing address

4170 S Decatur Blvd Ste C1
Las Vegas, NV 89103-5863
Phone (702) 659-8827

Other identifiers 8

IdentifierTypeStateIssuer
1982056172MedicaidNV
1891867107MedicaidNV
1003116146MedicaidNV
1316606874MedicaidNV
1497120059MedicaidNV
1003127499OtherNVINDIVIDUAL NPI
1225338361MedicaidNV
1407281561MedicaidNV

Other names 1

  • NVMH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140212000603 NV Part B Supplier - Clinic/Group Practice 3678702701 Receives reassigned benefits from 2 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

6767 W Tropicana Ave
Ste 219
Las Vegas, NV 89103
Phone (702) 659-8827

4170 S Decatur Blvd
Ste C1
Las Vegas, NV 89103
Phone (702) 659-8827

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1598015240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 S DECATUR BLVD STE C1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035863",
            "telephone_number": "702-659-8827",
            "fax_number": "702-852-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 S DECATUR BLVD STE C1",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891035863",
            "telephone_number": "702-659-8827",
            "fax_number": "702-852-0984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUEVA VIDA MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "REZANOV",
        "authorized_official_first_name": "MARYSOL",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "702-659-8827"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "6215-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982056172",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891867107",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003116146",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316606874",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497120059",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1003127499",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225338361",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407281561",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NVMH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NVMH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.