MEDICARE: JINU NIKI LMFT, LCADC

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	106H00000X	Marriage & Family Therapist	LMFT #82465	CA
2	106H00000X	Marriage & Family Therapist	LMFT #01350	NV

General Provider Information

NPI Number	:	1700184538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINU NIKI LMFT, LCADC

Provider Business Mailing Address
First Line	:	10120 W FLAMINGO RD
Second Line	:	STE 4-2043
City	:	LAS VEGAS
State	:	NV
Zip	:	89147
Country	:	US
Telephone Number	:	213-393-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2808
Country	:	US
Telephone Number	:	213-393-0522
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	05/18/2023

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