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General NPI Number Information
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NPI Number | 1629804687
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Entity Type | Organization
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Legal Business Name | INSPIRING WELLNESS TREATMENT & MANAGEMENT SERVICES
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 3339 W WASHINGTON AVE
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City | LAS VEGAS
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State | NV
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Zip | 89107
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Country | US
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Telephone | 702-788-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 N MARTIN L KING BLVD UNIT 271258
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City | LAS VEGAS
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State | NV
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Zip | 89127-8859
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Country | US
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Telephone | 702-900-8720
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | ANDREW J FREEMAN
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Credential | PHD
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Telephone | 702-900-8720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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