| Shiode Psychotherapy, Inc. | |
|
501 S. Rancho Dr. Ste I-64 Las Vegas NV 89106 | |
| (702) 384-4110 | |
| (702) 384-7954 |
| Full Name | Shiode Psychotherapy, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 501 S. Rancho Dr., Las Vegas, Nevada |
| Authorized Official Name and Position | Daniel T Shiode (PRESIDENT) |
| Authorized Official Contact | 7023844110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shiode Psychotherapy, Inc. 501 S. Rancho Dr. Ste I-64 Las Vegas NV 89106 Ph: (702) 384-4110 | Shiode Psychotherapy, Inc. 501 S. Rancho Dr. Ste I-64 Las Vegas NV 89106 Ph: (702) 384-4110 |
| NPI Number | 1326178310 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 06/19/2009 |
| Medicare PECOS PAC ID | 7315191145 |
|---|---|
| Medicare Enrollment ID | O20130204000076 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326178310 | NPI | - | NPPES |
| 002602062 | Medicaid | NV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY0244 (Nevada) | Primary |
| Provider Name | Daniel T Shiode |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1013047091 PECOS PAC ID: 4385669316 Enrollment ID: I20051010000436 |
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