MEDICARE: JENNIFER MITZEL LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1295147205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MITZEL LCSW

Provider Business Mailing Address
First Line	:	3551 E BONANZA RD
Second Line	:	101
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0055
Country	:	US
Telephone Number	:	702-359-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 E BONANZA RD
Second Line	:	101
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-0055
Country	:	US
Telephone Number	:	702-359-9410
Fax Number	:

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

Provider Enumeration Date	:	05/24/2014
Last Update Date	:	08/05/2014

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