MEDICARE: VALERIE KAYE ANTHONY

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
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1447680806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE KAYE ANTHONY

Provider Business Mailing Address
First Line	:	10598 MEDICINE BOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4906
Country	:	US
Telephone Number	:	209-499-5201
Fax Number	:

Provider Business Practice Location Address
First Line	:	10598 MEDICINE BOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4906
Country	:	US
Telephone Number	:	209-499-5201
Fax Number	:

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

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

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