Healthcare Provider Details

I. General information

NPI: 1427829167
Provider Name (Legal Business Name): VEGAS VALLEY WHOLE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 S TENAYA WAY STE 180
LAS VEGAS NV
89113-1929
US

IV. Provider business mailing address

6655 S TENAYA WAY STE 180
LAS VEGAS NV
89113-1929
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-7611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL T MORROW
Title or Position: PRESIDENT
Credential:
Phone: 702-463-7611