Healthcare Provider Details

I. General information

NPI: 1215402672
Provider Name (Legal Business Name): WELLNESS BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WELLNESS WAY
LAS VEGAS NV
89106-4108
US

IV. Provider business mailing address

1701 WELLNESS WAY # 200
LAS VEGAS NV
89106-4108
US

V. Phone/Fax

Practice location:
  • Phone: 702-310-9110
  • Fax: 702-366-0231
Mailing address:
  • Phone: 702-310-9110
  • Fax: 702-310-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MONICA RIOS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 702-310-9110