MEDICARE: MS. HOLLY ADELE ANDRES MSW

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 Social Worker	4097-C	NV

General Provider Information

NPI Number	:	1033172028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY ADELE ANDRES MSW

Provider Business Mailing Address
First Line	:	7500 W LAKE MEAD BLVD
Second Line	:	SUITE 9-472
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0297
Country	:	US
Telephone Number	:	702-810-4122
Fax Number	:	702-240-1625

Provider Business Practice Location Address
First Line	:	2441 TECH CENTER CT
Second Line	:	SUITE 109
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0804
Country	:	US
Telephone Number	:	702-810-4122
Fax Number	:	702-240-1625

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/10/2009

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