MEDICARE: DR. MELANIE BISON PHD, LCPC, LCADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	CP0134	NV

General Provider Information

NPI Number	:	1891903407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELANIE BISON PHD, LCPC, LCADC

Provider Business Mailing Address
First Line	:	4132 S RAINBOW BLVD
Second Line	:	SUITE 149
City	:	LAS VEGAS
State	:	NV
Zip	:	89103
Country	:	US
Telephone Number	:	725-222-9502
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 S RAINBOW BLVD STE 4007
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2506
Country	:	US
Telephone Number	:	725-222-9502
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/21/2022

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