MEDICARE: IESHA CHANEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023520723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IESHA CHANEY

Provider Business Mailing Address
First Line	:	4175 N. RANCHO DRIVE
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-0266
Country	:	US
Telephone Number	:	702-601-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 N RANCHO DR STE 160
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3472
Country	:	US
Telephone Number	:	702-601-4747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	09/17/2021

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Directions to “ IESHA CHANEY ” Practice Location

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