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General NPI Number Information
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NPI Number | 1871317149
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Entity Type | Organization
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Legal Business Name | LAS VEGAS WELLNESS COLLECTIVE LLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1230 W OWENS AVE STE 1
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City | LAS VEGAS
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State | NV
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Zip | 89106-2451
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Country | US
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Telephone | 702-703-4881
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Fax |
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Provider Business Mailing Address
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Address Line | 8046 PAVAROTTI AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-8264
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Country | US
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Telephone | 702-337-4793
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JSHAUNTAE MARSHALL
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Credential | DOULA
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Telephone | 702-337-4793
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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