MEDICARE: HIGH VIBES THERAPY CIRLE AND SELFCARE SALON PLLC

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

General Provider Information

NPI Number	:	1245088624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH VIBES THERAPY CIRLE AND SELFCARE SALON PLLC

Provider Business Mailing Address
First Line	:	3330 LAS VEGAS BLVD N APT 1026
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1530
Country	:	US
Telephone Number	:	682-331-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 LAS VEGAS BLVD N APT 1026
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1530
Country	:	US
Telephone Number	:	682-331-0707
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. CECILY GINNEL FERNANDEZ
Credential	:	MFTI
Telephone Number	:	682-331-0707

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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