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General NPI Number Information
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NPI Number | 1427659465
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Entity Type | Organization
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Legal Business Name | DR THERAPY MENTAL WELLNESS CENTERS
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 2915 W CHARLESTON BLVD STE 125
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City | LAS VEGAS
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State | NV
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Zip | 89102-1939
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Country | US
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Telephone | 702-204-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 4112 HELENS POUROFF AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89085-4460
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Country | US
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Telephone | 702-204-0150
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Fax | 702-998-7772
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Authorized Official
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Title or Position | MEMBER
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Name | MS. BRYCELYN N FURR-PATTON
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Credential |
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Telephone | 702-204-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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 | 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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