Healthcare Provider Details

I. General information

NPI: 1437909777
Provider Name (Legal Business Name): BEYOND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 W FLAMINGO RD STE 106
LAS VEGAS NV
89103-0165
US

IV. Provider business mailing address

PO BOX 30085
LAS VEGAS NV
89173-0085
US

V. Phone/Fax

Practice location:
  • Phone: 725-543-2935
  • Fax: 855-903-4377
Mailing address:
  • Phone: 855-380-6136
  • Fax: 800-235-1408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 855-380-6136