MEDICARE: MS. LISA MOFFETT LCSW

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	1041C0700X	Clinical	7423C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821006297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MOFFETT LCSW

Provider Business Mailing Address
First Line	:	PO BOX 336764
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89033-6764
Country	:	US
Telephone Number	:	702-846-7674
Fax Number	:	702-921-3333

Provider Business Practice Location Address
First Line	:	3085 S Jones Blvd Suite D
Second Line	:
City	:	Las Vegas
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-846-7674
Fax Number	:	702-921-3333

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/22/2017

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