MEDICARE: JOHN PALLETT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790990349	OTHER	NV	LDS FAMILY SERVICES

General Provider Information

NPI Number	:	1932566163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PALLETT

Provider Business Mailing Address
First Line	:	3175 E WARM SPRINGS RD STE 136
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3138
Country	:	US
Telephone Number	:	702-502-1469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 E WARM SPRINGS RD STE 136
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3138
Country	:	US
Telephone Number	:	702-502-1469
Fax Number	:

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	12/23/2024

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