MEDICARE: GARY LENKEIT, PHD, LTD

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	103TC0700X	Clinical Psychologist	PY248	NV

General Provider Information

NPI Number	:	1356507859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY LENKEIT, PHD, LTD

Provider Business Mailing Address
First Line	:	1820 E WARM SPRINGS RD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4549
Country	:	US
Telephone Number	:	702-263-0094
Fax Number	:	702-361-5080

Provider Business Practice Location Address
First Line	:	1820 E WARM SPRINGS RD
Second Line	:	SUITE 115
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4549
Country	:	US
Telephone Number	:	702-263-0094
Fax Number	:	702-361-5080

Authorized Official
Title or Position	:	OWNER, PSYCHOLOGIST
Name	:	DR. GARY C LENKEIT
Credential	:	PH.D.
Telephone Number	:	702-263-0094

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	05/23/2011

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