MEDICARE: ADVANCED COUNSELING GROUP,LLC

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	251S00000X	Community/Behavioral Health Agency	2001973.237	NV

General Provider Information

NPI Number	:	1164669479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED COUNSELING GROUP,LLC

Provider Business Mailing Address
First Line	:	3170 E SUNSET RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2745
Country	:	US
Telephone Number	:	702-782-7689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 E SUNSET RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2745
Country	:	US
Telephone Number	:	702-782-7689
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SOMPONG COOPER
Credential	:	BSW
Telephone Number	:	702-782-7679

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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