| NPI | 1538712351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK WISE Owner 702-604-2498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2019-07-21 |
| Last Update Date | 2025-05-31 |