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NPI Code Detail

MEDICARE: MRS. EMILY JANE BERSON M.A.

MEDICARE: MRS. EMILY JANE BERSON 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
1106H00000XMarriage & Family TherapistMI0898NV

General Provider Information

NPI Number : 1093218448
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMILY JANE BERSON M.A.
Provider Business Mailing Address
First Line : 1515 S MOJAVE RD SPC 107
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-4532
Country : US
Telephone Number : 702-595-4498
Fax Number :
Provider Business Practice Location Address
First Line : 2801 S VALLEY VIEW BLVD STE 6
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0166
Country : US
Telephone Number : 702-922-7015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2018
Last Update Date : 03/13/2018

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