MEDICARE: ZANYAE G ALLEN M.E.D., QMHP, LCPC

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	101YP2500X	Professional Counselor	CI0229	NV

General Provider Information

NPI Number	:	1750733218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZANYAE G ALLEN M.E.D., QMHP, LCPC

Provider Business Mailing Address
First Line	:	5516 BOULDER HWY STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6000
Country	:	US
Telephone Number	:	702-881-1234
Fax Number	:	651-602-3634

Provider Business Practice Location Address
First Line	:	5516 BOULDER HWY STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-6000
Country	:	US
Telephone Number	:	702-881-1234
Fax Number	:	651-602-3634

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

Provider Enumeration Date	:	07/08/2016
Last Update Date	:	02/23/2021

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