MEDICARE: TYRONE A HEWITT

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1841605920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONE A HEWITT

Provider Business Mailing Address
First Line	:	PO BOX 34831
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-4831
Country	:	US
Telephone Number	:	707-592-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 COPPER MOON LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1908
Country	:	US
Telephone Number	:	707-592-6625
Fax Number	:

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

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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Directions to “ TYRONE A HEWITT ” Practice Location

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