Basic Information
| Provider Information | |||||||||
| NPI: | 1023635273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATNESS THROUGH WELLNESS SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2350 S JONES BLVD STE 206 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022142147 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2350 S JONES BLVD STE 206MON85 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891463103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022142147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2020 | ||||||||
| LastUpdateDate: | 07/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRAXTON | ||||||||
| AuthorizedOfficialFirstName: | EVORA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7022019523 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.