MEDICARE: MRS. TAMARA LEE JONES

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	01352 I	NV

General Provider Information

NPI Number	:	1619371416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA LEE JONES

Provider Business Mailing Address
First Line	:	1161 S LOOP RD
Second Line	:	SUITE B
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4764
Country	:	US
Telephone Number	:	775-751-6990
Fax Number	:	775-751-6992

Provider Business Practice Location Address
First Line	:	1161 S LOOP RD
Second Line	:	SUITE B
City	:	PAHRUMP
State	:	NV
Zip	:	89048-4764
Country	:	US
Telephone Number	:	775-751-6990
Fax Number	:	775-751-6992

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

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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