Keoni Azevedo

Key facts

NPI

1497314850

Entity type

Individual (NPI type 1)

Primary specialty

Counselor 101Y00000X

Practice address

714 E Sahara Ave Ste 103714E
Las Vegas, NV 89104-2942

Phone

(702) 369-8700

NPI assigned

Jun 10, 2019

Sex

Male

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vegas Valley Comprehensive Counseling, LLC Mental Health Counselor · Las Vegas, NV · NPI 1598329062
  Medicare reassignment NPD NV

Medicare Care Compare profile

Specialty

Mental Health Counselor

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 10, 2019.

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1497314850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 E SAHARA AVE STE 103714E",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891042942",
            "telephone_number": "702-369-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 E SAHARA AVE STE 103714E",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891042942",
            "telephone_number": "702-369-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZEVEDO",
        "first_name": "KEONI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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