Healthcare Provider Details

I. General information

NPI: 1407644750
Provider Name (Legal Business Name): TITAN WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E WARM SPRINGS RD STE 104-106
LAS VEGAS NV
89119-4227
US

IV. Provider business mailing address

265 E WARM SPRINGS RD STE 104-106
LAS VEGAS NV
89119-4227
US

V. Phone/Fax

Practice location:
  • Phone: 617-447-8103
  • Fax: 772-873-9997
Mailing address:
  • Phone: 617-447-8103
  • Fax: 772-873-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATERINA CAULFIELD
Title or Position: OWNER
Credential:
Phone: 617-447-8103