MEDICARE: CLEARWATERS FAMILY GUIDANCE AND WELLNESS CENTERS 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	C20101008-0249	NV
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1730489154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEARWATERS FAMILY GUIDANCE AND WELLNESS CENTERS LLC

Provider Business Mailing Address
First Line	:	3606 N RANCHO DR STE 142
Second Line	:	LAS VEGAS
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3130
Country	:	US
Telephone Number	:	702-778-5300
Fax Number	:	702-778-5301

Provider Business Practice Location Address
First Line	:	3606 N RANCHO DR
Second Line	:	STE 142
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3195
Country	:	US
Telephone Number	:	702-778-5300
Fax Number	:	702-778-5301

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	MS. TRINA L ROBINSON
Credential	:	LMFT
Telephone Number	:	702-278-0984

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	02/10/2025

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