MEDICARE: KRISTINE A PETERS CADC-I

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	02358-1	NV

General Provider Information

NPI Number	:	1346700580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE A PETERS CADC-I

Provider Business Mailing Address
First Line	:	6706 CYPRESS PARK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2754
Country	:	US
Telephone Number	:	702-682-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 E BONANZA RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-2198
Country	:	US
Telephone Number	:	702-682-6635
Fax Number	:

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

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	03/22/2019

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Directions to “ KRISTINE A PETERS CADC-I” Practice Location

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