MEDICARE: MIGNON ELIZABETH PASQUALICCHIO MFT

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	106H00000X	Marriage & Family Therapist	01023	NV

General Provider Information

NPI Number	:	1255401600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGNON ELIZABETH PASQUALICCHIO MFT

Provider Business Mailing Address
First Line	:	6171 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-6136
Fax Number	:

Provider Business Practice Location Address
First Line	:	6171 W CHARLESTON BLVD STE 16
Second Line	:	8205 FAWN BROOK COURT, LV, NV 89149
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-6136
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	03/29/2010

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