MEDICARE: NICOLE O'HARTZ L.C.S.W

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	1041C0700X	Clinical Social Worker	5495-C	NV

General Provider Information

NPI Number	:	1801190863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE O'HARTZ L.C.S.W

Provider Business Mailing Address
First Line	:	1516 E TROPICANA AVE
Second Line	:	290, 291
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6525
Country	:	US
Telephone Number	:	702-413-6360
Fax Number	:	702-413-6364

Provider Business Practice Location Address
First Line	:	1516 E TROPICANA AVE
Second Line	:	290, 291
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6525
Country	:	US
Telephone Number	:	702-413-6360
Fax Number	:	702-413-6364

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	NICOLE CHUCKALINE O'HARTZ
Credential	:	L.C.S.W
Telephone Number	:	702-413-6360

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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