MEDICARE: LAVATTA CARLETTE PALM

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	172V00000X	Community Health Worker	CHW2-5007	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	07537-1	NV

General Provider Information

NPI Number	:	1053717991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVATTA CARLETTE PALM

Provider Business Mailing Address
First Line	:	4792 E UTAH AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5926
Country	:	US
Telephone Number	:	702-583-8805
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 S FORT APACHE RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5616
Country	:	US
Telephone Number	:	702-588-8600
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	01/28/2025

Similar Medicare Providers

1346071370 — MISSION TREATMENT CENTERS, INC.
Practice Location Address:

6080 S FORT APACHE RD STE 105
LAS VEGAS, NV
89148-5616

Practice Phone: 702-703-5848
Practice Fax:

1841342102 — GUITA TABASSI DO LTD
Practice Location Address:

6080 S FORT APACHE RD , SUITE 110
LAS VEGAS, NV
89148-5616

Practice Phone: 702-871-0303
Practice Fax: 702-562-0054

1841519915 — ANTHONY NGUYEN DO
Practice Location Address:

6080 S FORT APACHE RD STE 110
LAS VEGAS, NV
89148-5616

Practice Phone: 702-268-2820
Practice Fax:

1780280941 — NOVATIO, PLLC
Practice Location Address:

6080 S FORT APACHE RD STE 110
LAS VEGAS, NV
89148-5616

Practice Phone: 702-984-7557
Practice Fax:

1730979055 — SOUTHERN HILLS COMPREHENSIVE TREATMENT CENTER
Practice Location Address:

6080 S FORT APACHE RD STE 105
LAS VEGAS, NV
89148-5616

Practice Phone: 702-703-5848
Practice Fax:

1306636634 — SHEREE ANNTIONETTE ROLLING LPN
Practice Location Address:

6080 S FORT APACHE RD STE 105
LAS VEGAS, NV
89148-5616

Practice Phone: 702-703-5848
Practice Fax:

Directions to “ LAVATTA CARLETTE PALM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.