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NPI Code Detail

MEDICARE: TASHEBA DAVIS

MEDICARE:   TASHEBA  DAVIS
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
1106H00000XMarriage & Family TherapistMI0542NV

General Provider Information

NPI Number : 1689089708
Entity Type Code : Individual
Provider Name (Legal Business Name) : TASHEBA DAVIS
Provider Business Mailing Address
First Line : 6661 SILVERSTREAM AVE APT 2100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1174
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6661 SILVERSTREAM AVE APT 2100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-1174
Country : US
Telephone Number : 702-807-9329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2014
Last Update Date : 06/26/2014

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Directions to “ TASHEBA DAVIS ” Practice Location

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