MEDICARE: MS. ELENA DE SALVO MA MFT

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	86866	CA
2	106H00000X	Marriage & Family Therapist	2612-R	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033640628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELENA DE SALVO MA MFT

Provider Business Mailing Address
First Line	:	2780 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5857
Country	:	US
Telephone Number	:	702-820-3061
Fax Number	:

Provider Business Practice Location Address
First Line	:	2780 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5857
Country	:	US
Telephone Number	:	702-820-3061
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/20/2019

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