MEDICARE: MELVIN MCCALL

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1154753085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN MCCALL

Provider Business Mailing Address
First Line	:	1700 NORTH LAMB BLVD
Second Line	:	APARTMENT 232
City	:	LAS VEGAS
State	:	NV
Zip	:	89115
Country	:	US
Telephone Number	:	702-353-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	3216 WEST CHARLESTON BLVD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-544-4172
Fax Number	:

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

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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