MEDICARE: PATRICIA ANN BRASSFIELD PHD LTD

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	103TC0700X	Clinical Psychologist	PYO325	NV

General Provider Information

NPI Number	:	1053624619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICIA ANN BRASSFIELD PHD LTD

Provider Business Mailing Address
First Line	:	PO BOX 35968
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5968
Country	:	US
Telephone Number	:	702-370-8484
Fax Number	:	775-537-2388

Provider Business Practice Location Address
First Line	:	7200 CATHEDRAL ROCK DR
Second Line	:	SUITE 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0438
Country	:	US
Telephone Number	:	702-370-8484
Fax Number	:	775-537-2388

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA ANN BRASSFIELD
Credential	:	PH D
Telephone Number	:	702-370-8484

Provider Enumeration Date	:	07/23/2010
Last Update Date	:	03/12/2014

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