MEDICARE: WILLIAM HENRI MANARD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1043584048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HENRI MANARD

Provider Business Mailing Address
First Line	:	6778 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-4156
Country	:	US
Telephone Number	:	702-469-3042
Fax Number	:	702-459-5584

Provider Business Practice Location Address
First Line	:	2770 S MARYLAND PKWY
Second Line	:	SUITE 211
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1554
Country	:	US
Telephone Number	:	702-675-3400
Fax Number	:	702-675-3403

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

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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