MEDICARE: JASMINE GILLIS QMHA

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1285007609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE GILLIS QMHA

Provider Business Mailing Address
First Line	:	6600 W CHARLESTON BLVD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1067
Country	:	US
Telephone Number	:	702-689-3647
Fax Number	:

Provider Business Practice Location Address
First Line	:	8014 ARCADIAN LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-3700
Country	:	US
Telephone Number	:	702-689-3647
Fax Number	:

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

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	11/06/2015

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