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NPI Code Detail

MEDICARE: DIVINE WELLNESS LAS VEGAS

MEDICARE: DIVINE WELLNESS LAS VEGAS
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor
3104100000XSocial Worker
4106H00000XMarriage & Family Therapist
51041C0700XClinical Social Worker

General Provider Information

NPI Number : 1811849383
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE WELLNESS LAS VEGAS
Provider Business Mailing Address
First Line : 6960 OBANNON DR STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-2160
Country : US
Telephone Number : 702-292-4073
Fax Number :
Provider Business Practice Location Address
First Line : 6960 OBANNON DR STE 110
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-2160
Country : US
Telephone Number : 702-292-4073
Fax Number :
Authorized Official
Title or Position : OWNER
Name : STEPHEN GIST
Credential :
Telephone Number : 702-292-4073
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “DIVINE WELLNESS LAS VEGAS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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