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General NPI Number Information
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NPI Number | 1821890401
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Entity Type | Organization
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Legal Business Name | MAISON DE THERAPY PLLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 2151 VILLAGE WALK DR APT 25102
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City | HENDERSON
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State | NV
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Zip | 89012-5779
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Country | US
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Telephone | 702-550-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 732 S 6TH ST STE R
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City | LAS VEGAS
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State | NV
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Zip | 89101-6948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANASTASIA SLAVINA
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Credential | LMFT
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Telephone | 702-550-2633
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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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