Healthcare Provider Details

I. General information

NPI: 1396135612
Provider Name (Legal Business Name): OTIUM MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 SAINT ROSE PKWY SUITE 306
HENDERSON NV
89074-7772
US

IV. Provider business mailing address

2470 ST. ROSE PARKWAY SUITE 306
HENDERSON NV
89074-7772
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-8623
  • Fax: 702-664-0438
Mailing address:
  • Phone: 702-578-8623
  • Fax: 702-664-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV20151024554
License Number StateNV

VIII. Authorized Official

Name: MRS. LINDA ESTRELLA WOLFE
Title or Position: OWNER
Credential: LMFT, CADC
Phone: 702-578-8623