MEDICARE: MRS. NICOLE MCDONAGH CPC, LCADC, LCADC-S

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	07378-LC	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	07517LCS	NV
3	374J00000X	Doula	3215-21	NV
4	101YM0800X	Mental Health Counselor	CP5377	NV

General Provider Information

NPI Number	:	1811538317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE MCDONAGH CPC, LCADC, LCADC-S

Provider Business Mailing Address
First Line	:	6362 MCLEOD DR STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4433
Country	:	US
Telephone Number	:	702-483-1990
Fax Number	:	702-831-8812

Provider Business Practice Location Address
First Line	:	6362 MCLEOD DR STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4433
Country	:	US
Telephone Number	:	702-483-1990
Fax Number	:	702-831-8812

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

Provider Enumeration Date	:	10/05/2019
Last Update Date	:	01/05/2025

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