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NPI Code Detail

MEDICARE: MS. JEANINE MICHELLE WIMBERLY MFT

MEDICARE: MS. JEANINE MICHELLE WIMBERLY MFT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1023NV
2106H00000XMarriage & Family Therapist0860NV

General Provider Information

NPI Number : 1760639900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANINE MICHELLE WIMBERLY MFT
Provider Business Mailing Address
First Line : 1901 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1260
Country : US
Telephone Number : 702-486-0000
Fax Number : 702-486-7759
Provider Business Practice Location Address
First Line : 1901 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1260
Country : US
Telephone Number : 702-486-0000
Fax Number : 702-486-7759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 08/31/2025

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