Healthcare Provider Details

I. General information

NPI: 1467298562
Provider Name (Legal Business Name): TORIA WYSOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/24/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 GENTLE DAWN AVE
NORTH LAS VEGAS NV
89084-2058
US

IV. Provider business mailing address

1848 GENTLE DAWN AVE
N LAS VEGAS NV
89084-2058
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-5982
  • Fax:
Mailing address:
  • Phone: 702-578-5982
  • Fax:

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: