MEDICARE: GROWTHSPRING COUNSELING AND 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	251S00000X	Community/Behavioral Health Agency	5276-C	NV

General Provider Information

NPI Number	:	1417267469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWTHSPRING COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	2775 S JONES BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5631
Country	:	US
Telephone Number	:	702-685-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 S JONES BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5631
Country	:	US
Telephone Number	:	702-685-3300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HAVI MANDELL
Credential	:	PHD, LCSW
Telephone Number	:	702-685-3300

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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