MEDICARE: WILLIAM COVINGTON

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1861803959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM COVINGTON

Provider Business Mailing Address
First Line	:	5528 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3194
Country	:	US
Telephone Number	:	702-677-5169
Fax Number	:	702-478-9491

Provider Business Practice Location Address
First Line	:	5528 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3194
Country	:	US
Telephone Number	:	702-677-5169
Fax Number	:	702-478-9491

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

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	05/12/2014

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Directions to “ WILLIAM COVINGTON ” Practice Location

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