MEDICARE: MR. JOSEPH PATRICK MINNICK JR. LMSW, CADC,CSW-I

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	07761-C	NV
2	101YM0800X	Mental Health Counselor	IC-2890	NV
3	104100000X	Social Worker	4160-S	NV

General Provider Information

NPI Number	:	1255958799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH PATRICK MINNICK JR. LMSW, CADC,CSW-I

Provider Business Mailing Address
First Line	:	1065 E FLAMINGO RD APT 722
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7453
Country	:	US
Telephone Number	:	702-275-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 E FLAMINGO RD APT 722
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7453
Country	:	US
Telephone Number	:	170-227-5722
Fax Number	:

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

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	12/30/2025

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