MEDICARE: MS. SUE E DANIEL 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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1821194903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE E DANIEL MFT

Provider Business Mailing Address
First Line	:	6550 S PECOS RD
Second Line	:	BLDG B SUITE 127
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-898-1711
Fax Number	:	775-537-2388

Provider Business Practice Location Address
First Line	:	6550 S PECOS RD
Second Line	:	BLDG B SUITE 127
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-898-1711
Fax Number	:	775-537-2388

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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