MEDICARE: DARREN SUMBRY

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	:	1780074658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN SUMBRY

Provider Business Mailing Address
First Line	:	212 ALEXANDER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2626
Country	:	US
Telephone Number	:	701-419-0871
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 ALEXANDER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2626
Country	:	US
Telephone Number	:	701-419-0871
Fax Number	:

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

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	02/06/2015

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Directions to “ DARREN SUMBRY ” Practice Location

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