MEDICARE: COLLEEN SISLEY 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	0818	NV

General Provider Information

NPI Number	:	1255451977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN SISLEY MFT

Provider Business Mailing Address
First Line	:	7473 W LAKE MEAD BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0265
Country	:	US
Telephone Number	:	702-655-5033
Fax Number	:	702-562-1204

Provider Business Practice Location Address
First Line	:	7473 W LAKE MEAD BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0265
Country	:	US
Telephone Number	:	702-655-5033
Fax Number	:	702-562-1204

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	11/15/2023

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Directions to “ COLLEEN SISLEY MFT” Practice Location

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