MEDICARE: ROBERT HAWKINS COMMUNITY COUNSELING SERVICES

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	106H00000X	Marriage & Family Therapist	01522	NV

General Provider Information

NPI Number	:	1053890020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT HAWKINS COMMUNITY COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	350 E DESERT INN RD UNIT E103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-9004
Country	:	US
Telephone Number	:	323-682-3045
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 E DESERT INN RD UNIT E103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-9004
Country	:	US
Telephone Number	:	323-682-3045
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JACQUELINE M ANTHONY
Credential	:	LMFT
Telephone Number	:	323-682-3045

Provider Enumeration Date	:	08/10/2018
Last Update Date	:	08/10/2018

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