MEDICARE: JORDAN TALBOT

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		NV

General Provider Information

NPI Number	:	1932794237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN TALBOT

Provider Business Mailing Address
First Line	:	3425 CLIFF SHADOWS PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5111
Country	:	US
Telephone Number	:	702-673-4745
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 CLIFF SHADOWS PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5111
Country	:	US
Telephone Number	:	702-673-4745
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	03/08/2021

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Directions to “ JORDAN TALBOT ” Practice Location

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