Healthcare Provider Details

I. General information

NPI: 1407652241
Provider Name (Legal Business Name): THERAPY MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 W SAHARA AVE STE 103
LAS VEGAS NV
89146-3071
US

IV. Provider business mailing address

6465 W SAHARA AVE STE 103
LAS VEGAS NV
89146-3071
US

V. Phone/Fax

Practice location:
  • Phone: 702-595-5437
  • Fax: 702-425-2787
Mailing address:
  • Phone: 702-595-5437
  • Fax: 702-425-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARNIE ANNE LANCZ
Title or Position: DIRECTOR
Credential:
Phone: 702-556-3132