MEDICARE: DR. LEANNE LOUISE EARNEST PH.D.

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	103TC0700X	Clinical Psychologist	PYO 454	NV

General Provider Information

NPI Number	:	1295853240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEANNE LOUISE EARNEST PH.D.

Provider Business Mailing Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	D-307
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-222-1812
Fax Number	:	702-222-1786

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	D-307
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-222-1812
Fax Number	:	702-222-1786

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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