MEDICARE: GOLD CLINICAL SERVICES LLC

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	1041C0700X	Clinical Social Worker
2	1041C0700X	Clinical Social Worker	6823C	NV

General Provider Information

NPI Number	:	1518473032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD CLINICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD STE 3010
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6814
Country	:	US
Telephone Number	:	702-875-6618
Fax Number	:	702-566-4575

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD STE 3010
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6814
Country	:	US
Telephone Number	:	702-875-6618
Fax Number	:	702-875-6618

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LAUREY RAY
Credential	:	CMBS
Telephone Number	:	702-268-5067

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	12/20/2017

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Directions to “GOLD CLINICAL SERVICES LLC ” Practice Location

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