MEDICARE: WHOLISTIC RECOVERY 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1669241535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC RECOVERY LLC

Provider Business Mailing Address
First Line	:	1881 STEVENS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6312
Country	:	US
Telephone Number	:	702-525-7918
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 STEVENS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6312
Country	:	US
Telephone Number	:	702-525-7918
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	OJOMA OKOTIE BROTHERS
Credential	:
Telephone Number	:	702-525-7918

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	11/06/2024

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Directions to “WHOLISTIC RECOVERY LLC ” Practice Location

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