MEDICARE: MS. MORGAN DIANNA GORST LMFT

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	4821	NV

General Provider Information

NPI Number	:	1124534011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MORGAN DIANNA GORST LMFT

Provider Business Mailing Address
First Line	:	3181 CALAMUS POINTE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6523
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7361 W CHARLESTON BLVD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1576
Country	:	US
Telephone Number	:	702-763-2340
Fax Number	:

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

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	09/17/2024

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