MEDICARE: CHERRY RICHARDSON BA HUMAN SERVICES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528395456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRY RICHARDSON BA HUMAN SERVICES

Provider Business Mailing Address
First Line	:	51 N PECOS RD
Second Line	:	SUITE 109-113
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4887
Country	:	US
Telephone Number	:	702-363-1730
Fax Number	:	702-639-1736

Provider Business Practice Location Address
First Line	:	51 N PECOS RD
Second Line	:	SUITE 109-113
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4887
Country	:	US
Telephone Number	:	702-363-1730
Fax Number	:	702-639-1736

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

Provider Enumeration Date	:	11/13/2009
Last Update Date	:	11/13/2009

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