Provider Demographics
NPI:1376964437
Name:ESSENTIAL WELLNESS SERVICES, INC.
Entity Type:Organization
Organization Name:ESSENTIAL WELLNESS SERVICES, INC.
Other - Org Name:ESSENTIAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-279-7503
Mailing Address - Street 1:6716 LAVENDER LILLY LN
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2943
Mailing Address - Country:US
Mailing Address - Phone:702-279-7503
Mailing Address - Fax:702-522-1575
Practice Address - Street 1:6716 LAVENDER LILLY LN
Practice Address - Street 2:UNIT 1
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2943
Practice Address - Country:US
Practice Address - Phone:702-279-7503
Practice Address - Fax:702-522-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131725272251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health