MEDICARE: SARA TRIBBLE CSWI

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
2	101YM0800X	Mental Health Counselor
3	225400000X	Rehabilitation Practitioner
4	1041C0700X	Clinical Social Worker	IC2050	NV

General Provider Information

NPI Number	:	1760008122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA TRIBBLE CSWI

Provider Business Mailing Address
First Line	:	3340 TOPAZ ST STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3906
Country	:	US
Telephone Number	:	702-755-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 TOPAZ ST STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3906
Country	:	US
Telephone Number	:	702-268-7604
Fax Number	:	702-442-8840

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	10/16/2022

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Directions to “ SARA TRIBBLE CSWI” Practice Location

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