MEDICARE: BRAD DEVLIN B.S.

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	:	1982900700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD DEVLIN B.S.

Provider Business Mailing Address
First Line	:	3061 JACARANDA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9162
Country	:	US
Telephone Number	:	702-523-3960
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 N BUFFALO DR
Second Line	:	STE 208
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0379
Country	:	US
Telephone Number	:	702-834-3884
Fax Number	:	702-834-3544

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

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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