Provider Demographics
NPI:1598475790
Name:MOOD RESILIENCE THERAPY, LLC
Entity Type:Organization
Organization Name:MOOD RESILIENCE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:702-540-7023
Mailing Address - Street 1:7904 HOLLY KNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-5478
Mailing Address - Country:US
Mailing Address - Phone:702-540-7023
Mailing Address - Fax:
Practice Address - Street 1:820 GASS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101
Practice Address - Country:US
Practice Address - Phone:702-540-7023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty