MEDICARE: MITCHEL EVANS B.S. HUMAN SERVICES

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1740578160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHEL EVANS B.S. HUMAN SERVICES

Provider Business Mailing Address
First Line	:	4650 N RAINBOW BLVD APT 1035
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5759
Country	:	US
Telephone Number	:	702-882-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 N RAINBOW BLVD APT 1035
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5759
Country	:	US
Telephone Number	:	702-882-9359
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	07/19/2011

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