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NPI Code Detail

MEDICARE: ODYSSEY WELLNESS INC.

MEDICARE: ODYSSEY WELLNESS INC.
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
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1508409954
Entity Type Code : Organization
Provider Name (Legal Business Name) : ODYSSEY WELLNESS INC.
Provider Business Mailing Address
First Line : 3067 E WARM SPRINGS RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3750
Country : US
Telephone Number : 702-202-0000
Fax Number : 702-920-8865
Provider Business Practice Location Address
First Line : 3067 E WARM SPRINGS RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3750
Country : US
Telephone Number : 702-202-0000
Fax Number : 702-920-8865
Authorized Official
Title or Position : PRESIDENT
Name : DR. SARAH AHMAD
Credential :
Telephone Number : 702-202-0000
Provider Enumeration Date : 10/17/2019
Last Update Date : 10/17/2019

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