MEDICARE: SOLOMON'S PORCH COUNSELING CENTER

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

General Provider Information

NPI Number	:	1285014977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMON'S PORCH COUNSELING CENTER

Provider Business Mailing Address
First Line	:	6767 W CHARLESTON BLVD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9004
Country	:	US
Telephone Number	:	702-629-6340
Fax Number	:	702-629-7928

Provider Business Practice Location Address
First Line	:	6767 W CHARLESTON BLVD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9004
Country	:	US
Telephone Number	:	702-629-6340
Fax Number	:	702-629-7928

Authorized Official
Title or Position	:	LCSW
Name	:	MARGARET O'NEIL
Credential	:
Telephone Number	:	702-629-6340

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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