MEDICARE: MRS. HELEN REBECCA MOORE BS

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1700195641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HELEN REBECCA MOORE BS

Provider Business Mailing Address
First Line	:	4425 S JONES BLVD
Second Line	:	SUITE D3
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3370
Country	:	US
Telephone Number	:	702-991-3150
Fax Number	:	866-658-4052

Provider Business Practice Location Address
First Line	:	4425 S JONES BLVD
Second Line	:	SUITE D3
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3370
Country	:	US
Telephone Number	:	702-991-3150
Fax Number	:	866-658-4052

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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