MEDICARE: MR. JOSHUA K LARGUSA-STEPHENS B.S. OF PSYCHOLGY

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	1604718566	NV

General Provider Information

NPI Number	:	1043647977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSHUA K LARGUSA-STEPHENS B.S. OF PSYCHOLGY

Provider Business Mailing Address
First Line	:	3420 BEDFORDSHIRE PL
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7370
Country	:	US
Telephone Number	:	702-499-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 EAST PATRICK LANE SUITE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4902
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:	702-998-6270

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

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	10/10/2013

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