MEDICARE: CHRISTINE G KAKAVULIAS

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	101YM0800X	Mental Health Counselor	90-0837799	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720343536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE G KAKAVULIAS

Provider Business Mailing Address
First Line	:	5130 S PECOS RD
Second Line	:	SUITE 2B
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1248
Country	:	US
Telephone Number	:	702-900-7397
Fax Number	:	888-753-3302

Provider Business Practice Location Address
First Line	:	5130 S PECOS RD
Second Line	:	SUITE 2B
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1248
Country	:	US
Telephone Number	:	702-900-7397
Fax Number	:	888-753-3302

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

Provider Enumeration Date	:	07/08/2012
Last Update Date	:	07/08/2012

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