MEDICARE: NICHELLE L SMALL

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	880148782	NV

General Provider Information

NPI Number	:	1114292182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHELLE L SMALL

Provider Business Mailing Address
First Line	:	45 W OWENS AVE
Second Line	:	132
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6802
Country	:	US
Telephone Number	:	702-399-5466
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 W OWENS AVE
Second Line	:	134
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6817
Country	:	US
Telephone Number	:	702-399-5466
Fax Number	:

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

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/29/2012

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Directions to “ NICHELLE L SMALL ” Practice Location

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