MEDICARE: PERSON-HOLISTIC INNOVATIONS (PHI), 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	251S00000X	Community/Behavioral Health Agency	NV20111369130	NV

General Provider Information

NPI Number	:	1265703441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSON-HOLISTIC INNOVATIONS (PHI), LLC

Provider Business Mailing Address
First Line	:	PO BOX 35586
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5586
Country	:	US
Telephone Number	:	702-518-4532
Fax Number	:

Provider Business Practice Location Address
First Line	:	7041 SUNHAMPTON AVE UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-1735
Country	:	US
Telephone Number	:	702-518-4532
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST, CEO
Name	:	MR. DANIEL ALLEN BERARDUCCI
Credential	:	CPC, ACS
Telephone Number	:	814-397-6793

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	03/19/2024

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