MEDICARE: CHRISTINE MICHELLE MCANINCH LCSW

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	1041C0700X	Clinical Social Worker	6553-C	NV
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1215244835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MICHELLE MCANINCH LCSW

Provider Business Mailing Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-673-7462
Fax Number	:	702-442-8900

Provider Business Practice Location Address
First Line	:	2980 S RAINBOW BLVD
Second Line	:	200A
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6531
Country	:	US
Telephone Number	:	702-673-7462
Fax Number	:	702-442-8900

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	04/02/2019

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