MEDICARE: MARLA ELLEN WINTERS LPCC

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	101YP2500X	Professional Counselor	457	CA

General Provider Information

NPI Number	:	1699364422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLA ELLEN WINTERS LPCC

Provider Business Mailing Address
First Line	:	8134 MADDINGLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7638
Country	:	US
Telephone Number	:	702-600-2013
Fax Number	:

Provider Business Practice Location Address
First Line	:	8134 MADDINGLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7638
Country	:	US
Telephone Number	:	702-600-2013
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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