MEDICARE: CREATIVE BEGINNINGS WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1043793342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE BEGINNINGS WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	3260 FOUNTAIN FALLS WAY UNIT 1037
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2227
Country	:	US
Telephone Number	:	702-281-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 FOUNTAIN FALLS WAY UNIT 1037
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2227
Country	:	US
Telephone Number	:	702-281-6670
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CREA DOSTER
Credential	:
Telephone Number	:	702-281-6670

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	09/12/2018

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