MEDICARE: DISCOVERY MIND & 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	106H00000X	Marriage & Family Therapist	MI0215	NV
2	251S00000X	Community/Behavioral Health Agency	NV20131195864	NV

General Provider Information

NPI Number	:	1487997805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY MIND & WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE
Second Line	:	STE 419
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-373-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4616 W SAHARA AVE
Second Line	:	STE 419
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-968-9372
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	SANDRA L MILLER
Credential	:	LMFT
Telephone Number	:	702-968-9372

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	04/20/2015

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