MEDICARE: AMANDA LLOYD MFT-INTERN

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	225400000X	Rehabilitation Practitioner
2	106H00000X	Marriage & Family Therapist	MI0928	NV

General Provider Information

NPI Number	:	1528511391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LLOYD MFT-INTERN

Provider Business Mailing Address
First Line	:	10175 SPRING MOUNTAIN RD UNIT 2118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8481
Country	:	US
Telephone Number	:	702-335-7135
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 S WATER ST # 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-7226
Country	:	US
Telephone Number	:	702-823-4300
Fax Number	:

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

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	05/07/2018

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