MEDICARE: JENNIFER LORD

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	1403890855	NV

General Provider Information

NPI Number	:	1346548104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LORD

Provider Business Mailing Address
First Line	:	5737 BAFFY CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2686
Country	:	US
Telephone Number	:	307-690-0299
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 BAFFY CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2686
Country	:	US
Telephone Number	:	307-690-0299
Fax Number	:

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

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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Directions to “ JENNIFER LORD ” Practice Location

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