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General NPI Number Information
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NPI Number | 1912868175
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Entity Type | Organization
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Legal Business Name | OMINIRA THERAPY
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 02/09/2026
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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 | 702-546-6816
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Fax |
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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 | 702-482-8527
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DESTINIE CLEVELAND
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Credential | PADC CPC-INTERN NCC
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Telephone | 702-482-8527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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