MEDICARE: MRS. MICHELLE MICHEL-ELVIN 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	L189	NV
2	106H00000X	Marriage & Family Therapist	MFT367	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFT367	OTHER	NV	STATE LICENSE

General Provider Information

NPI Number	:	1588725980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MICHEL-ELVIN MFT

Provider Business Mailing Address
First Line	:	1771 E FLAMINGO RD
Second Line	:	SUITE 112B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5155
Country	:	US
Telephone Number	:	702-641-2422
Fax Number	:	702-893-9655

Provider Business Practice Location Address
First Line	:	1771 E FLAMINGO RD
Second Line	:	SUITE 112B
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5155
Country	:	US
Telephone Number	:	702-641-2422
Fax Number	:	702-893-9655

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	09/11/2025

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