MEDICARE: PROTEUS THERAPEUTIC SOLUTIONS INC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1518247311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROTEUS THERAPEUTIC SOLUTIONS INC

Provider Business Mailing Address
First Line	:	1813 SIERRA OAKS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 SIERRA OAKS LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134
Country	:	US
Telephone Number	:	845-436-9233
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY LEE
Credential	:
Telephone Number	:	845-436-9233

Provider Enumeration Date	:	08/24/2011
Last Update Date	:	08/24/2011

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