Provider Demographics
NPI:1114556222
Name:AROMA FUNCTIONAL NUTRITION PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:AROMA FUNCTIONAL NUTRITION PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:702-907-7924
Mailing Address - Street 1:1180 N TOWN CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6308
Mailing Address - Country:US
Mailing Address - Phone:702-907-7924
Mailing Address - Fax:725-210-0600
Practice Address - Street 1:1180 N TOWN CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6308
Practice Address - Country:US
Practice Address - Phone:702-907-7924
Practice Address - Fax:725-210-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty