MEDICARE: COMMUNITY COUNSELING OF LAS VEGAS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1730424318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING OF LAS VEGAS

Provider Business Mailing Address
First Line	:	10809 NOBLE MESA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5107
Country	:	US
Telephone Number	:	702-497-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	10809 NOBLE MESA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5107
Country	:	US
Telephone Number	:	702-497-7510
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MILTON M JONES
Credential	:
Telephone Number	:	702-497-7510

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	12/07/2012

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