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NPI Code Detail

MEDICARE: OLIVIA'S WELLNESS CENTER

MEDICARE: OLIVIA'S WELLNESS CENTER
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1427523463
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLIVIA'S WELLNESS CENTER
Provider Business Mailing Address
First Line : 2325 DAISY HILL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-1779
Country : US
Telephone Number : 909-634-9089
Fax Number :
Provider Business Practice Location Address
First Line : 2325 DAISY HILL AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-1779
Country : US
Telephone Number : 909-634-9089
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DAVION HAYNES
Credential :
Telephone Number : 909-634-9089
Provider Enumeration Date : 10/05/2018
Last Update Date : 10/05/2018

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Directions to “OLIVIA'S WELLNESS CENTER ” Practice Location

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