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NPI Code Detail

MEDICARE: DENEECA CAS WITTERN MFT-I

MEDICARE: DENEECA CAS WITTERN MFT-I
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
1106H00000XMarriage & Family TherapistMI4189NV

General Provider Information

NPI Number : 1922712637
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENEECA CAS WITTERN MFT-I
Provider Business Mailing Address
First Line : 10409 PACIFIC PALISADES AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-1221
Country : US
Telephone Number : 775-572-9910
Fax Number :
Provider Business Practice Location Address
First Line : 10409 PACIFIC PALISADES AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-1221
Country : US
Telephone Number : 775-572-9910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2023
Last Update Date : 01/16/2024

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