MEDICARE: JONEY KAROLA FELICIANO BOBE BA

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	106H00000X	Marriage & Family Therapist	000000	WA

General Provider Information

NPI Number	:	1306537782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONEY KAROLA FELICIANO BOBE BA

Provider Business Mailing Address
First Line	:	1250 WIGWAM PKWY UNIT 11204
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8366
Country	:	US
Telephone Number	:	706-751-1037
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 WIGWAM PKWY UNIT 11204
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8366
Country	:	US
Telephone Number	:	706-751-1037
Fax Number	:

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

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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