Provider Demographics
NPI:1487997805
Name:DISCOVERY MIND & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:DISCOVERY MIND & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-968-9372
Mailing Address - Street 1:4616 W SAHARA AVE
Mailing Address - Street 2:STE 419
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-3654
Mailing Address - Country:US
Mailing Address - Phone:702-373-5899
Mailing Address - Fax:
Practice Address - Street 1:4616 W SAHARA AVE
Practice Address - Street 2:STE 419
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3654
Practice Address - Country:US
Practice Address - Phone:702-968-9372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0215106H00000X
NVNV20131195864251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty