Provider Demographics
NPI:1639438450
Name:SIMPLY MOTIVATING
Entity Type:Organization
Organization Name:SIMPLY MOTIVATING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-201-3859
Mailing Address - Street 1:9150 MACKANOS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4920
Mailing Address - Country:US
Mailing Address - Phone:702-201-3859
Mailing Address - Fax:702-489-2885
Practice Address - Street 1:9150 MACKANOS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4920
Practice Address - Country:US
Practice Address - Phone:702-201-3859
Practice Address - Fax:702-489-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health