MEDICARE: MS. CARROL A MARQUIS MFT

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	0780	NV

General Provider Information

NPI Number	:	1588706576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARROL A MARQUIS MFT

Provider Business Mailing Address
First Line	:	9414 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-8312
Country	:	US
Telephone Number	:	702-233-8771
Fax Number	:	702-869-9807

Provider Business Practice Location Address
First Line	:	7341 W CHARLESTON BLVD
Second Line	:	SUITE 140
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1573
Country	:	US
Telephone Number	:	702-233-8771
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	04/17/2009

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