Healthcare Provider Details

I. General information

NPI: 1841045333
Provider Name (Legal Business Name): LIFE EMPOWERMENT CENTER OF NEVADA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 S RAINBOW BLVD STE A101
LAS VEGAS NV
89146-5183
US

IV. Provider business mailing address

8275 S EASTERN AVE STE 200
LAS VEGAS NV
89123-2545
US

V. Phone/Fax

Practice location:
  • Phone: 702-582-7369
  • Fax: 866-211-2764
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN CLARK
Title or Position: MANAGER
Credential:
Phone: 702-582-7369