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NPI Code Detail

MEDICARE: MR. MICHAEL EDWARD MAS LCSW, LADC

MEDICARE: MR. MICHAEL EDWARD MAS LCSW, LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0650-LNV
21041C0700XClinical Social Worker1992-CNV

General Provider Information

NPI Number : 1710091863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL EDWARD MAS LCSW, LADC
Provider Business Mailing Address
First Line : PO BOX 360001
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89036-8108
Country : US
Telephone Number : 702-636-3000
Fax Number :
Provider Business Practice Location Address
First Line : 916 W OWENS AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-2516
Country : US
Telephone Number : 702-636-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 12/18/2013

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