Provider Demographics
NPI:1831799915
Name:MENTAL EDGE THERAPY PROFESSIONAL LLC
Entity type:Organization
Organization Name:MENTAL EDGE THERAPY PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONAGH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC-I, LADC, CHT
Authorized Official - Phone:702-483-1990
Mailing Address - Street 1:2520 SAINT ROSE PKWY STE 220A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7789
Mailing Address - Country:US
Mailing Address - Phone:702-483-1990
Mailing Address - Fax:
Practice Address - Street 1:2520 SAINT ROSE PKWY STE 220A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7789
Practice Address - Country:US
Practice Address - Phone:702-483-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty