Provider Demographics
NPI:1194115436
Name:PROJECT WELLNESS LLC
Entity type:Organization
Organization Name:PROJECT WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MFT; CPC
Authorized Official - Phone:702-321-3789
Mailing Address - Street 1:8224 W CHARLESTON BLVD
Mailing Address - Street 2:#1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9096
Mailing Address - Country:US
Mailing Address - Phone:702-622-1105
Mailing Address - Fax:
Practice Address - Street 1:8224 W CHARLESTON BLVD
Practice Address - Street 2:#1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9096
Practice Address - Country:US
Practice Address - Phone:702-622-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV106H00000XMedicaid