MEDICARE: COUNSELING AND AWARENESS REHABILITATIVE EDUCATIOANL PROGRAM INC.

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
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	L791	NV

General Provider Information

NPI Number	:	1366744310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING AND AWARENESS REHABILITATIVE EDUCATIOANL PROGRAM INC.

Provider Business Mailing Address
First Line	:	1240 W OWENS AVE
Second Line	:	STE. 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2452
Country	:	US
Telephone Number	:	702-877-9850
Fax Number	:	702-877-9870

Provider Business Practice Location Address
First Line	:	1240 W OWENS AVE
Second Line	:	STE. 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2452
Country	:	US
Telephone Number	:	702-877-9850
Fax Number	:	702-877-9870

Authorized Official
Title or Position	:	DIRECTOR/ MENTAL HEALTH COUNSELOR
Name	:	MS. PENNY ANN JACKSON
Credential	:	M.A., LADC, SUP
Telephone Number	:	702-877-9850

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	11/24/2010

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