MEDICARE: KASIA ELIZABETH POLLOCK MS PSYCHOLOGY

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	101YM0800X	Mental Health Counselor	320800000X	NV

General Provider Information

NPI Number	:	1255805156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASIA ELIZABETH POLLOCK MS PSYCHOLOGY

Provider Business Mailing Address
First Line	:	2211 SIERRA SANTIAGO
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8607
Country	:	US
Telephone Number	:	928-219-1236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-2090
Country	:	US
Telephone Number	:	702-587-1798
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	01/14/2019

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