MEDICARE: CARLY SHADID 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	1004	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1004	OTHER	NV	NV BOARD OF MFT AND CPC

General Provider Information

NPI Number	:	1821480161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY SHADID MFT

Provider Business Mailing Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6019
Country	:	US
Telephone Number	:	702-850-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6019
Country	:	US
Telephone Number	:	702-850-1991
Fax Number	:

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

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	06/09/2026

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Directions to “ CARLY SHADID MFT” Practice Location

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