MEDICARE: MELISSA JACQUELINE MARIE HOWARD

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1083104574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JACQUELINE MARIE HOWARD

Provider Business Mailing Address
First Line	:	4428 W LAKE MEAD BLVD UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-6108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4428 WEST LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	805-248-6846
Fax Number	:

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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