MEDICARE: ROBERT SOUCY LPC, LCPC, LPCC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	00529-LC	NV
2	101YM0800X	Mental Health Counselor	CTB-2023-0648	NM
3	101YM0800X	Mental Health Counselor	LPC-21334	AZ
4	101YM0800X	Mental Health Counselor	202234677	MO
5	101YM0800X	Mental Health Counselor	CP5078-R	NV
6	101YM0800X	Mental Health Counselor	LPC.0017386	CO

General Provider Information

NPI Number	:	1053850636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SOUCY LPC, LCPC, LPCC

Provider Business Mailing Address
First Line	:	8732 AUTUMN VALLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7618
Country	:	US
Telephone Number	:	505-210-6098
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-382-7746
Fax Number	:

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

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	08/11/2025

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