Tracy Wiese, MFCT; MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

01200 Issued in NV

Practice address

3940 N Martin Luther King Boulevard
N Las Vegas, NV 89032

Phone

(702) 731-0909

Fax

(702) 724-1978

NPI assigned

Jul 10, 2010

Last updated

Jul 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IDEACA
• FHIR API: https://fhir4.healow.com/fhir/r4/IDEACA/Endpoint/IDEACA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Firstmed Health and Wellness Center Inc

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NV
  • NPI 1396054169
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1033421748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8936 SPANISH RIDGE AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891481354",
            "telephone_number": "702-998-2816",
            "fax_number": "702-998-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3940 N MARTIN LUTHER KING BOULEVARD",
            "city": "N LAS VEGAS",
            "state": "NV",
            "postal_code": "89032",
            "telephone_number": "702-731-0909",
            "fax_number": "702-724-1978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "TRACY",
        "credential": "MFCT; MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-10",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NV",
            "license": "01200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033421748",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Warren Wheelock, M.ED. BA/FLE
• Chappelle White
• Danisha White
• Whole Dietetics LLC
• Wholistic Wellness
• Mario Wilborn Jr.
• Naquail Sharnice Wilkerson
• William P Jacks MD Chartered
• Deante Martral Williams-Jones
• Brandy Williams

• Marriage & Family Therapist in N Las Vegas, NV
• Providers in N Las Vegas, NV by specialty
• Marriage & Family Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.