MEDICARE: MRS. BARBARA L QUALLS LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588954382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA L QUALLS LCSW

Provider Business Mailing Address
First Line	:	233 BREEZE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5131
Country	:	US
Telephone Number	:	702-606-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 BREEZE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5131
Country	:	US
Telephone Number	:	702-606-4662
Fax Number	:

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

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	12/14/2011

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