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NPI Code Detail

MEDICARE: GLENN MAKUPSON

MEDICARE: GLENN MAKUPSON
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
1101YM0800XMental Health CounselorNV

General Provider Information

NPI Number : 1336566504
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN MAKUPSON
Provider Business Mailing Address
First Line : 3636 LAS VEGAS BLVD N STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1556
Country : US
Telephone Number : 702-776-8397
Fax Number :
Provider Business Practice Location Address
First Line : 3636 LAS VEGAS BLVD N STE B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-1556
Country : US
Telephone Number : 702-776-8397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2014
Last Update Date : 03/25/2014

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Directions to “ GLENN MAKUPSON ” Practice Location

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