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NPI Code Detail

MEDICARE: TIFFANY ELAM

MEDICARE: TIFFANY ELAM
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538694484
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY ELAM
Provider Business Mailing Address
First Line : 8430 W LAKE MEAD BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-7674
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8430 W LAKE MEAD BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-7674
Country : US
Telephone Number : 702-576-9893
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2017
Last Update Date : 04/28/2017

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Directions to “ TIFFANY ELAM ” Practice Location

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