MEDICARE: DIRECT FOCUS COUNSELING GROUP

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265913842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT FOCUS COUNSELING GROUP

Provider Business Mailing Address
First Line	:	2590 WINDMILL LN STE 515
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5502
Country	:	US
Telephone Number	:	702-619-6755
Fax Number	:	702-780-7257

Provider Business Practice Location Address
First Line	:	1107 ALDENWOOD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3699
Country	:	US
Telephone Number	:	702-619-6755
Fax Number	:	702-780-7257

Authorized Official
Title or Position	:	CEO
Name	:	DR. GARY THOMAS MILLER
Credential	:
Telephone Number	:	702-619-6755

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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