Provider Demographics
NPI:1679888309
Name:GRACE AND WELLNESS, LLC
Entity type:Organization
Organization Name:GRACE AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED MENTAL HEALTH PROFESSIONA
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASKIN-MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LDAC
Authorized Official - Phone:702-240-9355
Mailing Address - Street 1:9175 LAS VEGAS BLVD S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3359
Mailing Address - Country:US
Mailing Address - Phone:702-240-9355
Mailing Address - Fax:
Practice Address - Street 1:9175 LAS VEGAS BLVD S
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3359
Practice Address - Country:US
Practice Address - Phone:702-240-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty