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General NPI Number Information
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NPI Number | 1780508192
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Entity Type | Organization
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Legal Business Name | OBSIDIAN THERAPY LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 732 S 6TH ST STE N
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City | LAS VEGAS
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State | NV
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Zip | 89101-6928
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Country | US
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Telephone | 918-816-8863
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Fax | 918-888-3800
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Provider Business Mailing Address
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Address Line | 732 S 6TH ST STE N
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City | LAS VEGAS
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State | NV
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Zip | 89101-6928
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Country | US
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Telephone | 918-816-8863
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Fax | 918-888-3800
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. NICOLE SOMMERSVILLE
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Credential | DMFT
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Telephone | 918-816-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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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