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NPI Code Detail

MEDICARE: AARON DAVIS

MEDICARE:   AARON  DAVIS
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
1101YM0800XMental Health Counselor
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1255798476
Entity Type Code : Individual
Provider Name (Legal Business Name) : AARON DAVIS
Provider Business Mailing Address
First Line : 9000 LAS VEGAS BLVD S UNIT 1085
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123
Country : US
Telephone Number : 478-714-6855
Fax Number :
Provider Business Practice Location Address
First Line : 9000 LAS VEGAS BLVD S UNIT 1085
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123
Country : US
Telephone Number : 478-714-6855
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2016
Last Update Date : 01/19/2016

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