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General NPI Number Information
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NPI Number | 1043621204
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Entity Type | Organization
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Legal Business Name | SERENITY THERAPY LLC
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 9414 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134-8312
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Country | US
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Telephone | 702-878-0554
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Fax |
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Provider Business Mailing Address
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Address Line | 9414 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89134-8312
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Country | US
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Telephone | 702-878-0554
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERTA VANDE VOORT
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Credential | MFT
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Telephone | 702-878-0554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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