MEDICARE: ONE LIFE THERAPY 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1740991439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE LIFE THERAPY LLC

Provider Business Mailing Address
First Line	:	6053 ASTER CREST CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2564
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6053 ASTER CREST CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2564
Country	:	US
Telephone Number	:	702-882-2303
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	TERRY FLORES
Credential	:	LCSW
Telephone Number	:	702-882-2303

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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Directions to “ONE LIFE THERAPY LLC ” Practice Location

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