MEDICARE: ENIKO MIMLESS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093006199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENIKO MIMLESS

Provider Business Mailing Address
First Line	:	10001 PEACE WAY
Second Line	:	2294
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 S JONES BLVD
Second Line	:	SUITE 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5653
Country	:	US
Telephone Number	:	702-888-0036
Fax Number	:

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

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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Directions to “ ENIKO MIMLESS ” Practice Location

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