MEDICARE: BROOKLYNN TENNELLE

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1578903290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYNN TENNELLE

Provider Business Mailing Address
First Line	:	5075 SPYGLASS HILL DR
Second Line	:	2041
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2776
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5075 SPYGLASS HILL DR
Second Line	:	2041
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-2776
Country	:	US
Telephone Number	:	858-254-6623
Fax Number	:

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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Directions to “ BROOKLYNN TENNELLE ” Practice Location

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