Provider Demographics
NPI:1073219143
Name:LOVINGLY BEHAVIORAL WELLNESS LLC
Entity Type:Organization
Organization Name:LOVINGLY BEHAVIORAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA/LBA
Authorized Official - Phone:702-763-5311
Mailing Address - Street 1:6390 W CHEYENNE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6390 W CHEYENNE AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6009
Practice Address - Country:US
Practice Address - Phone:702-763-5311
Practice Address - Fax:702-331-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty