MEDICARE: MRS. DANIELLE FORD-TARRANCE

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1518456029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE FORD-TARRANCE

Provider Business Mailing Address
First Line	:	1137 RED MARGIN CT UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4955
Country	:	US
Telephone Number	:	313-828-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 RED MARGIN CT UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4955
Country	:	US
Telephone Number	:	313-828-0107
Fax Number	:

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

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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