MEDICARE: MS. HILLARY MIRABAL

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	101Y00000X	Counselor	8336-C	NV
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386942647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HILLARY MIRABAL

Provider Business Mailing Address
First Line	:	5900 GORDON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2476
Country	:	US
Telephone Number	:	702-499-0270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3399 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3312
Country	:	US
Telephone Number	:	702-444-0438
Fax Number	:

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

Provider Enumeration Date	:	03/09/2011
Last Update Date	:	12/15/2023

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