Prime Sports & Wellness Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

PRIME SPORTS & WELLNESS CENTER LLC

Practice address

1700 E Desert Inn Rd Ste 113
Las Vegas, NV 89169-3206

Phone

(209) 688-8041

NPI assigned

Sep 23, 2019

Last updated

Sep 23, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adele McClendon

Title

Owner

Phone

(209) 688-8041

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1569196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569196800000",
    "number": "1528619350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E DESERT INN RD STE 113",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693206",
            "telephone_number": "209-688-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E DESERT INN RD STE 113",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891693206",
            "telephone_number": "209-688-8041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME SPORTS & WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-23",
        "last_updated": "2019-09-23",
        "status": "A",
        "authorized_official_last_name": "MCCLENDON",
        "authorized_official_first_name": "ADELE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-688-8041"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Las Vegas, NV
• Providers in 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 Sep 23, 2019; 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.