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NPI Code Detail

MEDICARE: LYNETHA ALLEN MFT INTERN

MEDICARE: LYNETHA ALLEN MFT INTERN
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 TherapistMI0230NV

General Provider Information

NPI Number : 1205133840
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNETHA ALLEN MFT INTERN
Provider Business Mailing Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 702-869-4300
Fax Number : 702-869-4301
Provider Business Practice Location Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 702-869-4300
Fax Number : 702-869-4301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2011
Last Update Date : 02/17/2011

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Directions to “ LYNETHA ALLEN MFT INTERN” Practice Location

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