NPIMap

Organization Active NPI

Brandy Nicole McCullouch

  • Community/Behavioral Health Agency
  • North Las Vegas, NV
National Provider Identifier
1699246660
Registry record updated Dec 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
BRANDY NICOLE MCCULLOUCH
Doing business as
Absolute Wellness Center LLC
Practice address
708 Cowboy Cross Ave
North Las Vegas, NV 89081-6746
Phone
(702) 337-8991
NPI assigned
Dec 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2018

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

Authorized official

Name
Brandy McCullouch
Title
Owner
Phone
(702) 337-8991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

708 Cowboy Cross Ave
North Las Vegas, NV 89081-6746

Mailing address

708 Cowboy Cross Ave
North Las Vegas, NV 89081-6746

Other identifiers 1

IdentifierTypeStateIssuer
1851765416MedicaidNV

Other names 1

  • Absolute Wellness Center LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Absolute Wellness Center LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1699246660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 COWBOY CROSS AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890816746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 COWBOY CROSS AVE",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890816746",
            "telephone_number": "702-337-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDY NICOLE MCCULLOUCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUCH",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-337-8991"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851765416",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Absolute Wellness Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.