Provider Demographics
NPI:1093161812
Name:HEALING TREE WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:HEALING TREE WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, CSW-INTERN
Authorized Official - Phone:702-277-5922
Mailing Address - Street 1:4270 S DECATUR BLVD STE A8
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6801
Mailing Address - Country:US
Mailing Address - Phone:702-277-5922
Mailing Address - Fax:
Practice Address - Street 1:4270 S DECATUR BLVD STE A8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6801
Practice Address - Country:US
Practice Address - Phone:702-277-5922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-952251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1972919561Medicaid