MEDICARE: SUSAN FITZPATRICK MILLER MFT

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	0610	NV

General Provider Information

NPI Number	:	1427124916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN FITZPATRICK MILLER MFT

Provider Business Mailing Address
First Line	:	3075 E FLAMINGO RD
Second Line	:	SUITE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7483
Country	:	US
Telephone Number	:	702-486-7511
Fax Number	:	702-486-7576

Provider Business Practice Location Address
First Line	:	3075 E FLAMINGO RD
Second Line	:	SUITE 108
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7483
Country	:	US
Telephone Number	:	702-486-7511
Fax Number	:	702-486-7576

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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