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General NPI Number Information
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NPI Number | 1235935537
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Entity Type | Organization
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Legal Business Name | ENLIGHTENED HEALING & WELLNESS
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 3191 S JONES BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89146-6703
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Country | US
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Telephone | 775-273-8031
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 784
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City | PANACA
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State | NV
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Zip | 89042-0784
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Country | US
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Telephone | 775-273-8031
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ELISSA EVANS
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Credential | LCSW
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Telephone | 775-273-8031
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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