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General NPI Number Information
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NPI Number | 1255028940
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Entity Type | Organization
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Legal Business Name | HALO HEALTH CLINIC INC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 400 SHADOW LN STE 207
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City | LAS VEGAS
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State | NV
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Zip | 89106-4358
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Country | US
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Telephone | 702-805-2069
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Fax |
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Provider Business Mailing Address
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Address Line | 400 SHADOW LN STE 207
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City | LAS VEGAS
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State | NV
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Zip | 89106-4358
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Country | US
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Telephone | 702-805-2069
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAUL MANLEY
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Credential |
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Telephone | 702-805-2069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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