MEDICARE: MRS. BRIONE A MINOR II

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	101YM0800X	Mental Health Counselor		NV

General Provider Information

NPI Number	:	1356869291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIONE A MINOR II

Provider Business Mailing Address
First Line	:	1129 CALICO RIDGE DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-3045
Country	:	US
Telephone Number	:	702-355-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 N JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1612
Country	:	US
Telephone Number	:	702-281-6769
Fax Number	:

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	08/30/2017

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