MEDICARE: TAMI MADSEN MA,LCPC STATE 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
1	101YM0800X	Mental Health Counselor	CI5720	NV

General Provider Information

NPI Number	:	1215862966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMI MADSEN MA,LCPC STATE INTERN

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	702-379-3191
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 S PAVILION CENTER DR STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4583
Country	:	US
Telephone Number	:	702-379-3191
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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