MEDICARE: MERCEDES ROBERTSON

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	:	1801210059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES ROBERTSON

Provider Business Mailing Address
First Line	:	700 COLLEGE DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89002-8419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-5340
Country	:	US
Telephone Number	:	702-487-3154
Fax Number	:

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

Provider Enumeration Date	:	02/08/2014
Last Update Date	:	04/25/2014

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