MEDICARE: MS. CHERYL MARIE HAJRI CADC-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	101YA0400X	Addiction (Substance Use Disorder) Counselor	33851	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33851	OTHER	TX	LICENSED CHEMICAL DEPENDENCY COUNSELOR INTERN

General Provider Information

NPI Number	:	1538675376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL MARIE HAJRI CADC-INTERN

Provider Business Mailing Address
First Line	:	10175 SPRING MOUNTAIN RD UNIT 1035
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8467
Country	:	US
Telephone Number	:	325-280-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 S PECOS RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5937
Country	:	US
Telephone Number	:	702-685-9220
Fax Number	:	702-685-2661

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

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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