MEDICARE: MS. DESIRAE YVETTE SANCHEZ

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

General Provider Information

NPI Number	:	1437567229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESIRAE YVETTE SANCHEZ

Provider Business Mailing Address
First Line	:	4688 TAMALPIAS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1638
Country	:	US
Telephone Number	:	702-355-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	6767 W CHARLESTON BLVD
Second Line	:	STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9073
Country	:	US
Telephone Number	:	702-629-6340
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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