MEDICARE: TREMAYNE ALLISON

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

General Provider Information

NPI Number	:	1386155935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREMAYNE ALLISON

Provider Business Mailing Address
First Line	:	PO BOX 335923
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-5923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6245 GREEN HERON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1415
Country	:	US
Telephone Number	:	323-945-8504
Fax Number	:

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

Provider Enumeration Date	:	10/21/2017
Last Update Date	:	10/21/2017

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