MEDICARE: KHEOMI ROLLINS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770025488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHEOMI ROLLINS

Provider Business Mailing Address
First Line	:	5909 VICTORY POINT ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3024
Country	:	US
Telephone Number	:	702-817-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	5909 VICTORY POINT ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-3024
Country	:	US
Telephone Number	:	702-789-8466
Fax Number	:

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

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	11/11/2016

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Directions to “ KHEOMI ROLLINS ” Practice Location

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