MEDICARE: LIVING WATERS INTERNATIONAL WOMEN'S MINISTRY

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1225364813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WATERS INTERNATIONAL WOMEN'S MINISTRY

Provider Business Mailing Address
First Line	:	911 N BUFFALO DR
Second Line	:	SUITE 208
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0379
Country	:	US
Telephone Number	:	702-834-3884
Fax Number	:	702-834-3544

Provider Business Practice Location Address
First Line	:	911 N BUFFALO DR
Second Line	:	SUITE 208
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0379
Country	:	US
Telephone Number	:	702-834-3884
Fax Number	:	702-834-3544

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	MRS. CHRISTINA LOUISE SANFORD
Credential	:	LCSW
Telephone Number	:	702-834-3884

Provider Enumeration Date	:	11/02/2009
Last Update Date	:	11/16/2010

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