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NPI Code Detail

MEDICARE: MS. MICHAELLE ANNE MCILVAINE BA, CADCI

MEDICARE: MS. MICHAELLE ANNE MCILVAINE BA, CADCI
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1427494541
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHAELLE ANNE MCILVAINE BA, CADCI
Provider Business Mailing Address
First Line : 10258 BETHEL MILL ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-5203
Country : US
Telephone Number : 702-385-2020
Fax Number : 702-658-0480
Provider Business Practice Location Address
First Line : 5659 DUNCAN DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-2811
Country : US
Telephone Number : 702-385-2020
Fax Number : 702-658-0480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2013
Last Update Date : 05/15/2013

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