MEDICARE: DAWN AND ALICE COUNSELING SERVICE

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	251B00000X	Case Management Agency		NV
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164859351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN AND ALICE COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	5185 CAMINO AL NORTE STE 120
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2416
Country	:	US
Telephone Number	:	702-600-9433
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 CAMINO AL NORTE STE 120
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-2416
Country	:	US
Telephone Number	:	702-600-9433
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARTHA LYNN WILLIAMS
Credential	:
Telephone Number	:	619-274-0030

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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Directions to “DAWN AND ALICE COUNSELING SERVICE ” Practice Location

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