Provider Demographics
NPI:1831824903
Name:MRTHERAPY WELLNESS SPACE, LLC
Entity type:Organization
Organization Name:MRTHERAPY WELLNESS SPACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-854-2168
Mailing Address - Street 1:304 S JONES BLVD # 4700
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:702-854-2168
Mailing Address - Fax:702-854-2168
Practice Address - Street 1:851 S RAMPART BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4884
Practice Address - Country:US
Practice Address - Phone:702-854-2168
Practice Address - Fax:702-854-2168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRTHERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3234-ROtherSTATE OF NEVADA BOARD OF EXAMINERS FOR MFT'S AND CPC'S