Provider Demographics
NPI:1396135612
Name:OTIUM MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:OTIUM MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ESTRELLA
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CADC
Authorized Official - Phone:702-578-8623
Mailing Address - Street 1:2470 ST. ROSE PARKWAY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7772
Mailing Address - Country:US
Mailing Address - Phone:702-578-8623
Mailing Address - Fax:702-664-0438
Practice Address - Street 1:2470 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7772
Practice Address - Country:US
Practice Address - Phone:702-578-8623
Practice Address - Fax:702-664-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-24
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151024554251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health