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NPI Code Detail

MEDICARE: KILEY ELLEFSON

MEDICARE: KILEY ELLEFSON
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1184138620
Entity Type Code : Individual
Provider Name (Legal Business Name) : KILEY ELLEFSON
Provider Business Mailing Address
First Line : 3320 N BUFFALO DR STE 203
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7411
Country : US
Telephone Number : 702-659-4825
Fax Number :
Provider Business Practice Location Address
First Line : 3320 N BUFFALO DR STE 203
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-7411
Country : US
Telephone Number : 702-659-4825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2017
Last Update Date : 05/13/2021

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Directions to “ KILEY ELLEFSON ” Practice Location

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