MEDICARE: ERIC RAYMOND HENTNIK

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	CI0233	NV

General Provider Information

NPI Number	:	1801335666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC RAYMOND HENTNIK

Provider Business Mailing Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-434-7290
Fax Number	:	702-434-6940

Provider Business Practice Location Address
First Line	:	3243 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3185
Country	:	US
Telephone Number	:	702-434-7290
Fax Number	:	702-434-6940

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

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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