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General NPI Number Information
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NPI Number | 1689254013
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Entity Type | Organization
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Legal Business Name | WISDOM & BLOOM PLLC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1180 N. TOWN CENTER DR. 100
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City | LAS VEGAS
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State | NV
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Zip | 89144
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Country | US
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Telephone | 702-525-6913
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Fax | 702-964-1371
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Provider Business Mailing Address
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Address Line | 2446 GRANADA BLUFF CT
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City | LAS VEGAS
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State | NV
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Zip | 89135-1341
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Country | US
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Telephone | 702-525-6913
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Fax | 702-964-1371
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SOPHIA A BARTONE
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Credential | LMFT
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Telephone | 702-525-6913
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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 |
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License Number State |
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