MEDICARE: PHASES OF LIFE CONSULTING

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	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1427325646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASES OF LIFE CONSULTING

Provider Business Mailing Address
First Line	:	8301 BOSECK DR # 16229
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-4554
Country	:	US
Telephone Number	:	702-858-7086
Fax Number	:	702-966-3839

Provider Business Practice Location Address
First Line	:	8301 BOSECK DR # 16229
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-4554
Country	:	US
Telephone Number	:	702-858-7086
Fax Number	:	702-966-3839

Authorized Official
Title or Position	:	CEO
Name	:	CAROLYN S PRIDGEON
Credential	:
Telephone Number	:	702-858-7086

Provider Enumeration Date	:	11/17/2011
Last Update Date	:	11/17/2011

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Directions to “PHASES OF LIFE CONSULTING ” Practice Location

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