MEDICARE: MS. MARY KAY SARGENT

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	106H00000X	Marriage & Family Therapist	MI0204	NV

General Provider Information

NPI Number	:	1285946152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KAY SARGENT

Provider Business Mailing Address
First Line	:	6765 W CHARLESTON BLVD
Second Line	:	SUITE #130
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2003
Country	:	US
Telephone Number	:	702-285-6157
Fax Number	:	702-631-9976

Provider Business Practice Location Address
First Line	:	6765 W CHARLESTON BLVD
Second Line	:	SUITE #130
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-2003
Country	:	US
Telephone Number	:	702-285-6157
Fax Number	:	702-631-9976

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	08/23/2010

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