MEDICARE: PHASES OF ME, INC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1962748038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASES OF ME, INC.

Provider Business Mailing Address
First Line	:	6624 SKY POINTE DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-408-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	6624 SKY POINTE DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-408-2868
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARVA BURR
Credential	:
Telephone Number	:	702-408-2868

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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