MEDICARE: OMINIRA 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1912868175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMINIRA THERAPY

Provider Business Mailing Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	702-482-8527
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6928
Country	:	US
Telephone Number	:	702-546-6816
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DESTINIE CLEVELAND
Credential	:	PADC CPC-INTERN NCC
Telephone Number	:	702-482-8527

Provider Enumeration Date	:	11/18/2025
Last Update Date	:	02/09/2026

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Directions to “OMINIRA THERAPY ” Practice Location

Language	Start Address	Practice Location

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