Wanda Leigh Clark- Gantt

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3925 N Martin L King Blvd Ste 117
North Las Vegas, NV 89032-7675

Phone

(702) 610-1715

NPI assigned

May 10, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Myracle 1 LLC

  • Community/Behavioral Health Agency
  • North Las Vegas, NV
  • NPI 1679297543
  NPD

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

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1366188575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 N MARTIN L KING BLVD STE 117",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890327675",
            "telephone_number": "702-610-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 N MARTIN L KING BLVD STE 117",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890327675",
            "telephone_number": "702-610-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK- GANTT",
        "first_name": "WANDA",
        "middle_name": "LEIGH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Civica Career and Collegiate Academy
• Paulette Clapano
• Nina Clark Anderson
• Nereida Clark Jacinto
• Clark Schillinger Emergency Group, PC
• Waiella L Clark-Stephens, MBA
• Allison Janette Clark
• Brandi L. Clark
• Calvin J Clark
• Chad Curtis Clark

• Mental Health Counselor in North Las Vegas, NV
• Providers in North Las Vegas, NV by specialty
• Mental Health Counselor in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.