MEDICARE: VELVET PETKOV

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	MI0843	NV

General Provider Information

NPI Number	:	1881121432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VELVET PETKOV

Provider Business Mailing Address
First Line	:	2253 MANOSQUE LN
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0446
Country	:	US
Telephone Number	:	702-292-6792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N GREEN VALLEY PKWY STE 116
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-2158
Country	:	US
Telephone Number	:	702-605-2766
Fax Number	:

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

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	05/15/2017

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Directions to “ VELVET PETKOV ” Practice Location

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