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NPI Code Detail

MEDICARE: WHOLENESS MENTAL HEALTH LLC

MEDICARE: WHOLENESS MENTAL HEALTH 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1679175442
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHOLENESS MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : 5604 HARMONY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2625
Country : US
Telephone Number : 702-910-0308
Fax Number :
Provider Business Practice Location Address
First Line : 5604 HARMONY AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2625
Country : US
Telephone Number : 702-910-0308
Fax Number :
Authorized Official
Title or Position : OWNER
Name : YANETCY CANCINO ACOSTA
Credential :
Telephone Number : 702-910-0308
Provider Enumeration Date : 11/16/2020
Last Update Date : 11/16/2020

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Directions to “WHOLENESS MENTAL HEALTH LLC ” Practice Location

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