Healthcare Provider Details

I. General information

NPI: 1770291403
Provider Name (Legal Business Name): LEVEL UP LIFE COACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD STE 320
LAS VEGAS NV
89149-4584
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD STE 320
LAS VEGAS NV
89149-4584
US

V. Phone/Fax

Practice location:
  • Phone: 702-779-6188
  • Fax:
Mailing address:
  • Phone: 702-779-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TASHANA JONES
Title or Position: OWNER
Credential: MA, MS, MFT-INTERN
Phone: 702-677-4724