MEDICARE: ANNETTE ELLISON CPC-I

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	101YP2500X	Professional Counselor	CI5020	NV

General Provider Information

NPI Number	:	1679146724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE ELLISON CPC-I

Provider Business Mailing Address
First Line	:	6552 MOUNTAINWOOD LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1037
Country	:	US
Telephone Number	:	702-755-2718
Fax Number	:

Provider Business Practice Location Address
First Line	:	2870 S JONES BLVD STE 115A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5643
Country	:	US
Telephone Number	:	702-755-2718
Fax Number	:

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

Provider Enumeration Date	:	07/16/2021
Last Update Date	:	07/16/2021

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Directions to “ ANNETTE ELLISON CPC-I” Practice Location

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