MEDICARE: NICOLE JACQUELINE CAUCHOIS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	01705-L	NV
2	101YM0800X	Mental Health Counselor	CP1135	NV
3	101YP2500X	Professional Counselor	CP1135	NV
4	101Y00000X	Counselor	CP1135	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346588159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JACQUELINE CAUCHOIS

Provider Business Mailing Address
First Line	:	4455 S PECOS RD STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5029
Country	:	US
Telephone Number	:	702-350-2056
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 S PECOS RD STE C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5029
Country	:	US
Telephone Number	:	702-505-1280
Fax Number	:

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

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	08/28/2019

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Directions to “ NICOLE JACQUELINE CAUCHOIS ” Practice Location

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