MEDICARE: SUGAR WOMACK

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	103K00000X	Behavior Analyst	1701875505	NV

General Provider Information

NPI Number	:	1710268693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUGAR WOMACK

Provider Business Mailing Address
First Line	:	PO BOX 5932
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-5932
Country	:	US
Telephone Number	:	304-487-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 E SUNSET RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2745
Country	:	US
Telephone Number	:	702-629-6000
Fax Number	:

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

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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Directions to “ SUGAR WOMACK ” Practice Location

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