MEDICARE: MISS EMMA L. CORO LMFT

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	106H00000X	Marriage & Family Therapist	MI1189	NV
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1710243662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMMA L. CORO LMFT

Provider Business Mailing Address
First Line	:	7016 RIO GRANDE GORGE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1012
Country	:	US
Telephone Number	:	702-353-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	6290 S PECOS RD STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-478-5080
Fax Number	:	702-297-6586

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	11/27/2023

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