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General NPI Number Information
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NPI Number | 1003553678
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Entity Type | Organization
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Legal Business Name | CENTRO YOLITIA LLC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 3450 E RUSSELL RD STE 104
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City | LAS VEGAS
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State | NV
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Zip | 89120-2201
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Country | US
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Telephone | 702-292-7026
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 E RUSSELL RD STE 104
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City | LAS VEGAS
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State | NV
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Zip | 89120-2201
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Country | US
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Telephone | 702-292-7026
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/OWNER
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Name | DR. GERARDO WENCE-MUNOZ
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Credential | LCPC
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Telephone | 702-292-7026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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