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General NPI Number Information
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NPI Number | 1487997805
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Entity Type | Organization
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Legal Business Name | DISCOVERY MIND & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 4616 W SAHARA AVE STE 419
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City | LAS VEGAS
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State | NV
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Zip | 89102-3654
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Country | US
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Telephone | 702-968-9372
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Fax |
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Provider Business Mailing Address
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Address Line | 4616 W SAHARA AVE STE 419
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City | LAS VEGAS
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State | NV
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Zip | 89102-3654
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Country | US
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Telephone | 702-373-5899
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SANDRA L MILLER
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Credential | LMFT
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Telephone | 702-968-9372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MI0215
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20131195864
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License Number State | NV
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