MEDICARE: DR. TRACY S MOORE-MERRELL MFT-I, PSY.D

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
2	106H00000X	Marriage & Family Therapist	MI0875	NV

General Provider Information

NPI Number	:	1447407408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY S MOORE-MERRELL MFT-I, PSY.D

Provider Business Mailing Address
First Line	:	304 S JONES BLVD STE 264
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-815-9494
Fax Number	:	702-553-3417

Provider Business Practice Location Address
First Line	:	304 S JONES BLVD STE 264
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	702-815-9494
Fax Number	:	702-553-3417

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	10/07/2020

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