Healthcare Provider Details

I. General information

NPI: 1073003521
Provider Name (Legal Business Name): B BEAUTY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 W OWENS AVE
LAS VEGAS NV
89106-2516
US

IV. Provider business mailing address

3569 UNIQUE WAY
LAS VEGAS NV
89129-6727
US

V. Phone/Fax

Practice location:
  • Phone: 971-240-0498
  • Fax:
Mailing address:
  • Phone: 971-240-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBETTE R WOODALL
Title or Position: OWNER
Credential:
Phone: 971-240-0498