MEDICARE: MS. TONYA DENISE TITSWORTH

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	:	1841591583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONYA DENISE TITSWORTH

Provider Business Mailing Address
First Line	:	814 HUNTERS RIDGE WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7829
Country	:	US
Telephone Number	:	702-516-2864
Fax Number	:

Provider Business Practice Location Address
First Line	:	814 HUNTERS RIDGE WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7829
Country	:	US
Telephone Number	:	702-516-2864
Fax Number	:

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

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	11/11/2010

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