Healthcare Provider Details

I. General information

NPI: 1407351356
Provider Name (Legal Business Name): WHOLE HEALTH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 DOVER BAY ST
LAS VEGAS NV
89129-2131
US

IV. Provider business mailing address

3529 DOVER BAY ST
LAS VEGAS NV
89129-2131
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-9917
  • Fax: 702-982-6888
Mailing address:
  • Phone: 702-485-9917
  • Fax: 702-982-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberM10548
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA WADSWORTH
Title or Position: OWNER
Credential: LMFT-I
Phone: 702-485-9917