MEDICARE: WELLNESS BEHAVIORAL HEALTH SERVICES 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1215402672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS BEHAVIORAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	1701 WELLNESS WAY # 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4108
Country	:	US
Telephone Number	:	702-310-9110
Fax Number	:	702-310-9114

Provider Business Practice Location Address
First Line	:	1701 WELLNESS WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4108
Country	:	US
Telephone Number	:	702-310-9110
Fax Number	:	702-366-0231

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MONICA RIOS
Credential	:
Telephone Number	:	702-310-9110

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/09/2019

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