Provider Demographics
NPI:1558993196
Name:FIRST STEP WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:FIRST STEP WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-489-1993
Mailing Address - Street 1:4650 W OAKEY BLVD APT 1054
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1507
Mailing Address - Country:US
Mailing Address - Phone:702-489-1993
Mailing Address - Fax:
Practice Address - Street 1:4650 W OAKEY BLVD APT 1054
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1507
Practice Address - Country:US
Practice Address - Phone:702-489-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty