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General NPI Number Information
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NPI Number | 1699075374
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Entity Type | Individual
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Provider Name | CARYL VON RUEDEN-BOSSART M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 121 S MARTIN LUTHER KING BLVD STE 172
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City | LAS VEGAS
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State | NV
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Zip | 89106-4309
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Country | US
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Telephone | 702-486-7451
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Fax | 702-486-8880
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Provider Business Mailing Address
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Address Line | 2021 RED ROCK ST
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City | LAS VEGAS
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State | NV
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Zip | 89146-3114
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Country | US
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Telephone | 702-367-0778
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0205
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License Number State | NV
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