MEDICARE: KEYSTONE COUNSELING AND CONSULTING, LLC

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	106H00000X	Marriage & Family Therapist	MI0248	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447508882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	10637 STRAND CITY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-7131
Country	:	US
Telephone Number	:	702-546-6214
Fax Number	:

Provider Business Practice Location Address
First Line	:	4155 N RANCHO DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3448
Country	:	US
Telephone Number	:	702-546-6214
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HANNAH S BRADLEY
Credential	:	LMFT
Telephone Number	:	702-546-6214

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/28/2019

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