Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1093019788 |
---|---|
Provider Name | Melissa Tavares |
First Address | Las Vegas, NV 89115-2851 |
Second Address | Las Vegas, NV 89115-2851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |