MEDICARE: CAROLYN T MOHLER LCSW

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	1041C0700X	Clinical Social Worker	2719-C	NV

General Provider Information

NPI Number	:	1063669083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN T MOHLER LCSW

Provider Business Mailing Address
First Line	:	1820 E WARM SPRINGS RD
Second Line	:	STE. 112
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4549
Country	:	US
Telephone Number	:	702-428-7651
Fax Number	:	702-568-5030

Provider Business Practice Location Address
First Line	:	1820 E WARM SPRINGS RD
Second Line	:	STE. 112
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4549
Country	:	US
Telephone Number	:	702-428-7651
Fax Number	:	702-568-5030

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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