MEDICARE: PALO VERDE CHILD & FAMILY SERVICES, INC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215172317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALO VERDE CHILD & FAMILY SERVICES, INC

Provider Business Mailing Address
First Line	:	2801 S VALLEY VIEW BLVD
Second Line	:	SUITE 10
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0116
Country	:	US
Telephone Number	:	702-243-4357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 S VALLEY VIEW BLVD
Second Line	:	SUITE 10
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-0116
Country	:	US
Telephone Number	:	702-243-4357
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. PAUL DENNIS WULKAN
Credential	:	PSY.D., LCSW
Telephone Number	:	702-243-4357

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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