MEDICARE: MISS NORMA BACH M.A.

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		NV
2	106H00000X	Marriage & Family Therapist		NV

General Provider Information

NPI Number	:	1063720159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NORMA BACH M.A.

Provider Business Mailing Address
First Line	:	9625 W RUSSELL RD APT 1132
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4545
Country	:	US
Telephone Number	:	702-629-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1771 E FLAMINGO RD # B12
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5155
Country	:	US
Telephone Number	:	702-629-9326
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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