Provider Demographics
NPI:1013567585
Name:MY THERAPY FE, LLC
Entity Type:Organization
Organization Name:MY THERAPY FE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:LACEY
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MFT
Authorized Official - Phone:702-808-9668
Mailing Address - Street 1:6201 EVENSAIL DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-6967
Mailing Address - Country:US
Mailing Address - Phone:702-808-9668
Mailing Address - Fax:
Practice Address - Street 1:7341 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:725-780-4488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health