MEDICARE: PRICILA LONGMIRE

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	171M00000X	Case Manager/Care Coordinator
2	101YM0800X	Mental Health Counselor	CI5008	NV

General Provider Information

NPI Number	:	1518260587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRICILA LONGMIRE

Provider Business Mailing Address
First Line	:	3763 WINTER WHITETAIL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3616
Country	:	US
Telephone Number	:	775-287-2395
Fax Number	:

Provider Business Practice Location Address
First Line	:	3763 WINTER WHITETAIL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3616
Country	:	US
Telephone Number	:	775-287-2395
Fax Number	:

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

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/24/2024

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Directions to “ PRICILA LONGMIRE ” Practice Location

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