MEDICARE: MELANIE YSAGUIRRE

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	LCSW92166	CA
2	101YM0800X	Mental Health Counselor	9137-C	NV
3	1041C0700X	Clinical Social Worker	9137-C	NV

General Provider Information

NPI Number	:	1457991317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE YSAGUIRRE

Provider Business Mailing Address
First Line	:	3525 W CHEYENNE AVE STE 106
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8250
Country	:	US
Telephone Number	:	702-791-9060
Fax Number	:

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

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	08/08/2023

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