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General NPI Number Information
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NPI Number | 1124771399
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Entity Type | Individual
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Provider Name | LATISHIA NICOLE WESLEY
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Gender | Female
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 2580 NORTH RANCHO DR
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032
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Country | US
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Telephone | 786-922-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 8209 SAN MATEO ST
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89085-2306
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Country | US
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Telephone | 786-922-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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