MEDICARE: MR. JAMES E CONNER

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

General Provider Information

NPI Number	:	1417258062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES E CONNER

Provider Business Mailing Address
First Line	:	6027 CASTLEMONT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-4753
Country	:	US
Telephone Number	:	702-565-4671
Fax Number	:	702-565-4671

Provider Business Practice Location Address
First Line	:	3651 LINDELL RD
Second Line	:	SUITE D
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1254
Country	:	US
Telephone Number	:	702-565-4671
Fax Number	:	702-565-4671

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

Provider Enumeration Date	:	11/14/2010
Last Update Date	:	11/21/2010

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Directions to “ MR. JAMES E CONNER ” Practice Location

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