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General NPI Number Information
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NPI Number | 1427494541
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Entity Type | Individual
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Provider Name | MICHAELLE ANNE MCILVAINE BA, CADCI
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Gender | Female
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 5659 DUNCAN DR
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City | LAS VEGAS
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State | NV
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Zip | 89130-2811
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Country | US
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Telephone | 702-385-2020
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Fax | 702-658-0480
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Provider Business Mailing Address
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Address Line | 10258 BETHEL MILL ST
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City | LAS VEGAS
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State | NV
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Zip | 89183-5203
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Country | US
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Telephone | 702-385-2020
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Fax | 702-658-0480
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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