MEDICARE: YAMILE LANDRIAN MFT-I

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	106H00000X	Marriage & Family Therapist	MI0874	NV

General Provider Information

NPI Number	:	1134779697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAMILE LANDRIAN MFT-I

Provider Business Mailing Address
First Line	:	1895 N GREEN VALLEY PKWY APT 1813
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 N DURANGO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3916
Country	:	US
Telephone Number	:	702-919-5907
Fax Number	:

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

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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