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General NPI Number Information
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NPI Number | 1265930549
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Entity Type | Organization
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Legal Business Name | SERENITY MIND SPA
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 7495 W AZURE DR STE 237
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City | LAS VEGAS
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State | NV
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Zip | 89130-4437
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Country | US
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Telephone | 702-680-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 7495 W AZURE DR STE 237
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City | LAS VEGAS
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State | NV
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Zip | 89130-4437
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Country | US
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Telephone | 702-680-9350
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Fax |
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Authorized Official
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Title or Position | CPC-I
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Name | MRS. LA TOYA WILLIAMS
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Credential | QMHP
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Telephone | 702-680-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 101YP2500X
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License Number State | NV
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