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General NPI Number Information
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NPI Number | 1215544085
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Entity Type | Organization
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Legal Business Name | HONESTY WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 9729 ALEUTIAN ST
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City | LAS VEGAS
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State | NV
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Zip | 89178-3843
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Country | US
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Telephone | 702-967-5739
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Fax |
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Provider Business Mailing Address
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Address Line | 9729 ALEUTIAN ST
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City | LAS VEGAS
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State | NV
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Zip | 89178-3843
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Country | US
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Telephone | 702-967-5739
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TRACY BROOKS
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Credential |
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Telephone | 702-559-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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