Provider Demographics
NPI:1841542339
Name:WHOLE LIFE HEALTH THERAPY AND WELLNESS CENTER
Entity type:Organization
Organization Name:WHOLE LIFE HEALTH THERAPY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-321-6222
Mailing Address - Street 1:4550 W OAKEY BLVD
Mailing Address - Street 2:STE 99A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1506
Mailing Address - Country:US
Mailing Address - Phone:702-321-6222
Mailing Address - Fax:
Practice Address - Street 1:4550 W OAKEY BLVD
Practice Address - Street 2:STE 99A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1581
Practice Address - Country:US
Practice Address - Phone:702-321-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLE LIFE HEALTH SUPPORT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health