MEDICARE: WHOLE HEALTH COUNSELING 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	101YP2500X	Professional Counselor	M10548	NV
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1407351356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLE HEALTH COUNSELING LLC

Provider Business Mailing Address
First Line	:	3529 DOVER BAY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2131
Country	:	US
Telephone Number	:	702-485-9917
Fax Number	:	702-982-6888

Provider Business Practice Location Address
First Line	:	3529 DOVER BAY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-2131
Country	:	US
Telephone Number	:	702-485-9917
Fax Number	:	702-982-6888

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA WADSWORTH
Credential	:	LMFT-I
Telephone Number	:	702-485-9917

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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