MEDICARE: FLT INTERVENTIONS

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1366045346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLT INTERVENTIONS

Provider Business Mailing Address
First Line	:	2928 VIGILANTE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6401
Country	:	US
Telephone Number	:	702-931-7479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 VIGILANTE CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6401
Country	:	US
Telephone Number	:	702-931-7479
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VERNAL LAURAINE GLADSTONE
Credential	:	MFTI
Telephone Number	:	702-931-7479

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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Directions to “FLT INTERVENTIONS ” Practice Location

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