MEDICARE: SERAPH DARK PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1386571347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERAPH DARK PLLC

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	725-900-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2037 SHINING FEATHER LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-2582
Country	:	US
Telephone Number	:	725-900-0224
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN
Name	:	SERAPH DARK
Credential	:	LCSW
Telephone Number	:	725-900-0224

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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