Provider Demographics
NPI:1508550666
Name:FLOURISH NEVADA COUNSELING AND WELLNESS PLLC
Entity Type:Organization
Organization Name:FLOURISH NEVADA COUNSELING AND WELLNESS PLLC
Other - Org Name:FLOURISH NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAITLIND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-453-6841
Mailing Address - Street 1:3495 LAKESIDE DR # 1231
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4841
Mailing Address - Country:US
Mailing Address - Phone:775-453-6841
Mailing Address - Fax:
Practice Address - Street 1:458 COURT ST STE 106
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1709
Practice Address - Country:US
Practice Address - Phone:775-453-6841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1043856198Medicaid