MEDICARE: MS. RITA PICKERING MFT

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	0535	NV

General Provider Information

NPI Number	:	1457436503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA PICKERING MFT

Provider Business Mailing Address
First Line	:	2840 E FLAMINGO RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5201
Country	:	US
Telephone Number	:	702-732-0153
Fax Number	:	702-732-0917

Provider Business Practice Location Address
First Line	:	2840 E FLAMINGO RD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5201
Country	:	US
Telephone Number	:	702-732-0153
Fax Number	:	702-732-0917

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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