MEDICARE: SARA LASHAE CARDWELL

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1639439532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LASHAE CARDWELL

Provider Business Mailing Address
First Line	:	612 HAUSE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4003
Country	:	US
Telephone Number	:	702-490-7140
Fax Number	:	702-396-7119

Provider Business Practice Location Address
First Line	:	612 HAUSE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4003
Country	:	US
Telephone Number	:	702-480-7140
Fax Number	:	702-396-7119

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

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	05/24/2012

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Directions to “ SARA LASHAE CARDWELL ” Practice Location

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