MEDICARE: HANNAH KALAMBAKAL MFT-INTERN

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	MI4510	NV

General Provider Information

NPI Number	:	1497649222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH KALAMBAKAL MFT-INTERN

Provider Business Mailing Address
First Line	:	328 IRON SUMMIT AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6865
Country	:	US
Telephone Number	:	916-730-8854
Fax Number	:

Provider Business Practice Location Address
First Line	:	7495 W AZURE DR STE 227
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4417
Country	:	US
Telephone Number	:	702-706-5145
Fax Number	:

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

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/05/2025

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