MEDICARE: MRS. LAURA ANN WILLMOTT

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1225474216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ANN WILLMOTT

Provider Business Mailing Address
First Line	:	9140 W LA MADRE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3509
Country	:	US
Telephone Number	:	702-219-1728
Fax Number	:

Provider Business Practice Location Address
First Line	:	9140 W LA MADRE WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3509
Country	:	US
Telephone Number	:	702-219-1728
Fax Number	:

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

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	05/16/2013

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Directions to “ MRS. LAURA ANN WILLMOTT ” Practice Location

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