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General NPI Number Information
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NPI Number | 1578247029
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Entity Type | Organization
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Legal Business Name | WISE MIND COUNSELING AND LIFE COACHING CENTER LLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 24 MARBLE APEX AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-6898
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Country | US
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Telephone | 702-675-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 24 MARBLE APEX AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-6898
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Country | US
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Telephone | 702-675-8007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LANEE ASHTON
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Credential |
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Telephone | 702-675-8007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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