=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285236380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARITY WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2020
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2840 E FLAMINGO RD STE A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89121-5201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-348-9654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9850 S MARYLAND PKWY STE A5-389
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89183-7146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-348-9654
-----------------------------------------------------
Fax | 702-940-7599
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR/THERAPIST
-----------------------------------------------------
Name | ASHIA Y MCREYNOLDS
-----------------------------------------------------
Credential | MA, LMFT, LCADC
-----------------------------------------------------
Telephone | 702-348-9654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------