MEDICARE: HANNAH NICOLE MCCALLSON

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	106S00000X	Behavior Technician	16-24356	NV
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1922558832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH NICOLE MCCALLSON

Provider Business Mailing Address
First Line	:	6628 SKY POINTE DR STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4071
Country	:	US
Telephone Number	:	702-704-5112
Fax Number	:	186-663-3925

Provider Business Practice Location Address
First Line	:	6628 SKY POINTE DR STE 114
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-4071
Country	:	US
Telephone Number	:	702-704-5112
Fax Number	:	186-663-3925

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	04/10/2018

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Directions to “ HANNAH NICOLE MCCALLSON ” Practice Location

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