MEDICARE: KATHY J CUNNINGHAM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		NV

General Provider Information

NPI Number	:	1184872590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY J CUNNINGHAM

Provider Business Mailing Address
First Line	:	513 WINDING OAK CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4578
Country	:	US
Telephone Number	:	702-813-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-813-1127
Fax Number	:

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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