MEDICARE: TORIA WYSOR

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1467298562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORIA WYSOR

Provider Business Mailing Address
First Line	:	1848 GENTLE DAWN AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-2058
Country	:	US
Telephone Number	:	702-578-5982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 GENTLE DAWN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2058
Country	:	US
Telephone Number	:	702-578-5982
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/24/2024

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Directions to “ TORIA WYSOR ” Practice Location

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