MEDICARE: MICHELLE ANDERSON

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

General Provider Information

NPI Number	:	1578081253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANDERSON

Provider Business Mailing Address
First Line	:	7575 W WASHINGTON AVE STE 127187
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4333
Country	:	US
Telephone Number	:	702-202-2449
Fax Number	:

Provider Business Practice Location Address
First Line	:	7575 W WASHINGTON AVE STE 127187
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4333
Country	:	US
Telephone Number	:	702-249-2449
Fax Number	:

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	01/08/2019

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Directions to “ MICHELLE ANDERSON ” Practice Location

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