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General NPI Number Information
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NPI Number | 1306179700
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Entity Type | Organization
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Legal Business Name | TRANSITIONAL WELLNESS CENTER
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 5852 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-3489
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Country | US
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Telephone | 702-339-0346
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Fax |
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Provider Business Mailing Address
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Address Line | 437 ENGEL AVE
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City | HENDERSON
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State | NV
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Zip | 89011-4357
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Country | US
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Telephone | 702-339-0346
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CATHY DONOVAN
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Credential | LCSW
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Telephone | 702-339-0346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2556-C
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License Number State | NV
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