MEDICARE: DR. MARIAH SCHWAN PSYD

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	103TC0700X	Clinical Psychologist	6301018907	MI
2	103TC0700X	Clinical Psychologist	PY1056	NV

General Provider Information

NPI Number	:	1942657077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIAH SCHWAN PSYD

Provider Business Mailing Address
First Line	:	6787 W TROPICANA AVE STE 241
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4759
Country	:	US
Telephone Number	:	833-624-5400
Fax Number	:	866-497-0441

Provider Business Practice Location Address
First Line	:	6787 W TROPICANA AVE STE 241
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-4759
Country	:	US
Telephone Number	:	833-624-5400
Fax Number	:	866-497-0441

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	09/28/2022

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