Healthcare Provider Details

I. General information

NPI: 1427659465
Provider Name (Legal Business Name): DR THERAPY MENTAL WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 W CHARLESTON BLVD STE 125
LAS VEGAS NV
89102-1939
US

IV. Provider business mailing address

4112 HELENS POUROFF AVE
NORTH LAS VEGAS NV
89085-4460
US

V. Phone/Fax

Practice location:
  • Phone: 702-204-0150
  • Fax:
Mailing address:
  • Phone: 702-204-0150
  • Fax: 702-998-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. BRYCELYN N FURR-PATTON
Title or Position: MEMBER
Credential:
Phone: 702-204-0150