MEDICARE: PROJECT WELLNESS 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	106H00000X	Marriage & Family Therapist	01197	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194115436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT WELLNESS LLC

Provider Business Mailing Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	#1
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-622-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	#1
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-622-1105
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	KIM BLAND
Credential	:	MFT; CPC
Telephone Number	:	702-321-3789

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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Directions to “PROJECT WELLNESS LLC ” Practice Location

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