MEDICARE: WAVES COUNSELING AND THERAPY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821815143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVES COUNSELING AND THERAPY

Provider Business Mailing Address
First Line	:	3175 E WARM SPRINGS RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3137
Country	:	US
Telephone Number	:	702-483-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	3175 E WARM SPRINGS RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3137
Country	:	US
Telephone Number	:	702-483-0356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE MOORE
Credential	:	CPC
Telephone Number	:	702-483-0356

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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