MEDICARE: A LIST FAMILY SERVICES, LLC

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	207R00000X	Internal Medicine Physician	NV5802	NV
2	101Y00000X	Counselor	CP0090	NV
3	363L00000X	Nurse Practitioner	APRN001471	NV
4	106H00000X	Marriage & Family Therapist
5	1041C0700X	Clinical Social Worker
6	104100000X	Social Worker
7	103K00000X	Behavior Analyst
8	101YM0800X	Mental Health Counselor
9	2084P0800X	Psychiatry Physician	NV10794	NV

General Provider Information

NPI Number	:	1184942815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A LIST FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	3960 E PATRICK LN STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4902
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:	702-998-6270

Provider Business Practice Location Address
First Line	:	3960 E PATRICK LN STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4902
Country	:	US
Telephone Number	:	702-998-6264
Fax Number	:	702-998-6270

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. UALAPA MIKA FONOTISATELE JR.
Credential	:	QMHA-ASSOCIATES
Telephone Number	:	702-321-9273

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	03/20/2015

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Directions to “A LIST FAMILY SERVICES, LLC ” Practice Location

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