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General NPI Number Information
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NPI Number | 1194115436
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Entity Type | Organization
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Legal Business Name | PROJECT WELLNESS LLC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 8224 W CHARLESTON BLVD #1
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City | LAS VEGAS
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State | NV
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Zip | 89117-9096
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Country | US
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Telephone | 702-622-1105
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Fax |
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Provider Business Mailing Address
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Address Line | 8224 W CHARLESTON BLVD #1
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City | LAS VEGAS
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State | NV
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Zip | 89117-9096
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Country | US
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Telephone | 702-622-1105
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | KIM BLAND
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Credential | MFT; CPC
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Telephone | 702-321-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 01197
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License Number State | NV
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