MEDICARE: FAITH IN LIFE COUNSELING CENTER

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	251S00000X	Community/Behavioral Health Agency	CP0028	NV

General Provider Information

NPI Number	:	1639489149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH IN LIFE COUNSELING CENTER

Provider Business Mailing Address
First Line	:	3663 E. SUNSET RD. STE. 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-496-6054
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 E SUNSET RD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3246
Country	:	US
Telephone Number	:	702-496-6054
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. TAMARA SUE MCMANIGELL
Credential	:	MSEDCPC
Telephone Number	:	702-496-6054

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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Directions to “FAITH IN LIFE COUNSELING CENTER ” Practice Location

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