Individual provider Active NPI

Christi Delynn Passalacqua

  • Marriage & Family Therapist
  • Las Vegas, NV
National Provider Identifier
1164766101
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MI0757 Issued in NV
Practice address
2921 N Tenaya Way
Las Vegas, NV 89128-1409
Phone
(702) 942-1774
NPI assigned
Nov 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Marriage & Family Therapist 106H00000X 35002260A IN
Marriage & Family Therapist 106H00000X MI0757 NV Primary

Addresses

Primary practice location

2921 N Tenaya Way
Las Vegas, NV 89128-1409

Mailing address

52358 Country Acres Dr
Elkhart, IN 46514-8800
Phone (702) 372-2446

Other practice location 1

755 W Carmel Dr Ste 209
Carmel, IN 46032-5878
Phone (702) 372-2446

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240216001858 NV Practitioner - Marriage and Family Therapist 3274977384 Reassigns benefits to 1 organization
I20240828004277 IN Practitioner - Marriage and Family Therapist 3274977384 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Health and Wellness LLCGroup PAC ID 9335363118, 11 clinicians

Practice addresses (Care Compare)

2921 N Tenaya Way
Las Vegas, NV 89128-1409
Phone (702) 338-8373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35002260AINMDMarriage & Family Therapist
MI0757NVMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Health and Wellness, LLC CurrentSince Jan 1, 2024 Accepting new patients
Legacy Health and Wellness, LLC CurrentSince Jan 1, 2024 Accepting new patients
Thrive Counseling LLC CurrentSince Aug 21, 2024 Accepting new patients

Locations

755 W Carmel Dr
Ste 209
Carmel, IN 46032
Phone (702) 372-2446

250 Main St
Ste 420
Lafayette, IN 47901
Phone (219) 885-3441

2921 N Tenaya Way
Las Vegas, NV 89128
Phone (702) 338-8373

2921 N Tenaya Way
Ste 126
Las Vegas, NV 89128

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1164766101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52358 COUNTRY ACRES DR",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465148800",
            "telephone_number": "702-372-2446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 N TENAYA WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891281409",
            "telephone_number": "702-942-1774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "755 W Carmel Dr Ste 209",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460325878",
            "country_code": "US",
            "telephone_number": "702-372-2446",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSALACQUA",
        "first_name": "CHRISTI",
        "middle_name": "DELYNN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IN",
            "license": "35002260A",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NV",
            "license": "MI0757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.