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NPI Code Detail

MEDICARE: MRS. MARIE J JACON-TYNDALL

MEDICARE: MRS. MARIE J JACON-TYNDALL
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1598064586
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARIE J JACON-TYNDALL
Provider Business Mailing Address
First Line : 5763 W OAKEY BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1248
Country : US
Telephone Number : 702-968-5001
Fax Number : 702-968-5004
Provider Business Practice Location Address
First Line : 5763 W OAKEY BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1248
Country : US
Telephone Number : 702-968-5001
Fax Number : 702-968-5004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2011
Last Update Date : 03/16/2011

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Directions to “ MRS. MARIE J JACON-TYNDALL ” Practice Location

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