MEDICARE: DR. DAVID PATRICK GENNIS PSY.D., LMFT

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	106H00000X	Marriage & Family Therapist	MFC46820	CA
2	106H00000X	Marriage & Family Therapist	#01166	NV

General Provider Information

NPI Number	:	1558439935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PATRICK GENNIS PSY.D., LMFT

Provider Business Mailing Address
First Line	:	3225 PERCHING BIRD LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2358
Country	:	US
Telephone Number	:	480-268-5723
Fax Number	:

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	09/22/2016

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