Provider Demographics
NPI:1447850144
Name:MENTAL EDGE THERAPY PROFESSIONAL LLC
Entity type:Organization
Organization Name:MENTAL EDGE THERAPY PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCDONAGH
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LCADC, LCADC-S
Authorized Official - Phone:702-483-1990
Mailing Address - Street 1:6362 MCLEOD DR STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4433
Mailing Address - Country:US
Mailing Address - Phone:702-483-1990
Mailing Address - Fax:702-831-8812
Practice Address - Street 1:6362 MCLEOD DR STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4433
Practice Address - Country:US
Practice Address - Phone:702-483-1990
Practice Address - Fax:702-831-8812
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL EDGE THERAPY PROFESSIONAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty