MEDICARE: MELISSA JEAN REECE-THOMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	103TB0200X	Cognitive & Behavioral Psychologist
4	222Q00000X	Developmental Therapist
5	251B00000X	Case Management Agency
6	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598251290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JEAN REECE-THOMPSON

Provider Business Mailing Address
First Line	:	3311 S RAINBOW BLVD STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-772-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 S RAINBOW BLVD STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6596
Country	:	US
Telephone Number	:	702-772-4446
Fax Number	:

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

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	01/17/2019

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