Healthcare Provider Details

I. General information

NPI: 1073436077
Provider Name (Legal Business Name): I T A L THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 E FLAMINGO RD STE G
LAS VEGAS NV
89119-0846
US

IV. Provider business mailing address

2290 E FLAMINGO RD STE G
LAS VEGAS NV
89119-0846
US

V. Phone/Fax

Practice location:
  • Phone: 702-812-0289
  • Fax:
Mailing address:
  • Phone: 702-812-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: REJINA FERGUSON-MCDOWELL
Title or Position: FOUNDER
Credential:
Phone: 702-573-4865