MEDICARE: MRS. TRINA COLETTE SQUALLS MBA, BSHCS

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		NV

General Provider Information

NPI Number	:	1336487982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINA COLETTE SQUALLS MBA, BSHCS

Provider Business Mailing Address
First Line	:	223 ZINC ST
Second Line	:	UNIT B
City	:	HENDERSON
State	:	NV
Zip	:	89015-5033
Country	:	US
Telephone Number	:	702-502-5459
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 E FLAMINGO RD
Second Line	:	STE# 158
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5258
Country	:	US
Telephone Number	:	702-385-9097
Fax Number	:

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

Provider Enumeration Date	:	01/16/2013
Last Update Date	:	01/16/2013

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