MEDICARE: ELIZABETH NMN MUNOZ-BRUECKMANN MFTI & CPCI

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	00315-P	NV
2	101YM0800X	Mental Health Counselor	CI0058	NV
3	106H00000X	Marriage & Family Therapist	MI0249	NV

General Provider Information

NPI Number	:	1902156847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NMN MUNOZ-BRUECKMANN MFTI & CPCI

Provider Business Mailing Address
First Line	:	PO BOX 531356
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89053-1356
Country	:	US
Telephone Number	:	702-364-1993
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1839
Country	:	US
Telephone Number	:	702-364-1993
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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