MEDICARE: EVELYN D ADELAJA, MFT

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	MF01094	NV

General Provider Information

NPI Number	:	1710279062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELYN D ADELAJA, MFT

Provider Business Mailing Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE 109C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-375-9458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 E FLAMINGO RD
Second Line	:	SUITE 109C
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5129
Country	:	US
Telephone Number	:	702-375-9458
Fax Number	:

Authorized Official
Title or Position	:	MARRIAGE AND FAMILY THERAPIST
Name	:	EVELYN DENISE ADELAJA
Credential	:	MFT
Telephone Number	:	702-375-9458

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	05/04/2011

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