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NPI Code Detail

MEDICARE: JODY MARSHALL LCPC, LCADC-S

MEDICARE: JODY MARSHALL LCPC, LCADC-S
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
2225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1629385604
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY MARSHALL LCPC, LCADC-S
Provider Business Mailing Address
First Line : 8565 S EASTERN AVE STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89123-2906
Country : US
Telephone Number : 702-217-5639
Fax Number : 702-441-1262
Provider Business Practice Location Address
First Line : 2840 E FLAMINGO RD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5201
Country : US
Telephone Number : 702-217-5639
Fax Number : 702-441-1262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2010
Last Update Date : 09/17/2024

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