MEDICARE: PEAVINE COUNSELING LLC

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	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1972272896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAVINE COUNSELING LLC

Provider Business Mailing Address
First Line	:	7117 LAKELAND RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6027
Country	:	US
Telephone Number	:	775-560-9623
Fax Number	:	866-348-2644

Provider Business Practice Location Address
First Line	:	480 W BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3227
Country	:	US
Telephone Number	:	775-560-9623
Fax Number	:	866-348-2644

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ULLA YANDELL
Credential	:	LCSW
Telephone Number	:	775-560-9623

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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Directions to “PEAVINE COUNSELING LLC ” Practice Location

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