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NPI Code Detail

MEDICARE: WITHERS FOR WARRIORS

MEDICARE: WITHERS FOR WARRIORS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2103TB0200XCognitive & Behavioral Psychologist
3103TC1900XCounseling Psychologist
4103TP2701XGroup Psychotherapy Psychologist
5106H00000XMarriage & Family Therapist
6101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1891269437
Entity Type Code : Organization
Provider Name (Legal Business Name) : WITHERS FOR WARRIORS
Provider Business Mailing Address
First Line : 2134 N GATEWAY RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-5304
Country : US
Telephone Number : 702-763-7377
Fax Number :
Provider Business Practice Location Address
First Line : 2134 N GATEWAY RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-5304
Country : US
Telephone Number : 702-763-7377
Fax Number :
Authorized Official
Title or Position : FOUNDER/OWNER
Name : JESSIE KUNTZ
Credential :
Telephone Number : 702-763-7377
Provider Enumeration Date : 01/16/2019
Last Update Date : 01/16/2019

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Directions to “WITHERS FOR WARRIORS ” Practice Location

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