MEDICARE: MRS. HALEY VANDA HAMMOND M.A.

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	101YP2500X	Professional Counselor	PC003365	PA

General Provider Information

NPI Number	:	1962783720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALEY VANDA HAMMOND M.A.

Provider Business Mailing Address
First Line	:	5419 W TROPICANA AVE
Second Line	:	#1714
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5419 W TROPICANA AVE
Second Line	:	#1714
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5060
Country	:	US
Telephone Number	:	724-388-9659
Fax Number	:

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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