MEDICARE: TINA WORKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336373869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WORKS

Provider Business Mailing Address
First Line	:	716 ANTIQUE SILVER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8202
Country	:	US
Telephone Number	:	323-743-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 ANTIQUE SILVER AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8202
Country	:	US
Telephone Number	:	323-743-0168
Fax Number	:

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

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	03/25/2023

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Directions to “ TINA WORKS ” Practice Location

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