MEDICARE: JAMES DART MFTI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	673	NV
2	106H00000X	Marriage & Family Therapist	MI0259	NV

General Provider Information

NPI Number	:	1164861415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DART MFTI

Provider Business Mailing Address
First Line	:	180 W HUFFAKER LN
Second Line	:	SUITE 303
City	:	RENO
State	:	NV
Zip	:	89511-2346
Country	:	US
Telephone Number	:	775-225-1501
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W HUFFAKER LN
Second Line	:	SUITE 303
City	:	RENO
State	:	NV
Zip	:	89511-2346
Country	:	US
Telephone Number	:	775-225-1501
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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