| Halo Health Clinic Inc | |
|
400 Shadow Ln Ste 207 Las Vegas NV 89106-4358 | |
| (702) 805-2069 | |
| Not Available |
| Full Name | Halo Health Clinic Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 400 Shadow Ln Ste 207, Las Vegas, Nevada |
| Authorized Official Name and Position | Paul Manley (OWNER) |
| Authorized Official Contact | 7028052069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Halo Health Clinic Inc 400 Shadow Ln Ste 207 Las Vegas NV 89106-4358 Ph: (702) 805-2069 | Halo Health Clinic Inc 400 Shadow Ln Ste 207 Las Vegas NV 89106-4358 Ph: (702) 805-2069 |
| NPI Number | 1255028940 |
|---|---|
| Provider Enumeration Date | 04/21/2023 |
| Last Update Date | 10/12/2023 |
| Certification Date | 10/12/2023 |
| Medicare PECOS PAC ID | 5092161737 |
|---|---|
| Medicare Enrollment ID | O20231031003939 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255028940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Munachi Queena Ezenwata |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194356733 PECOS PAC ID: 0749611598 Enrollment ID: I20200511001788 |
| Provider Name | Roscelle J Minoza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275153884 PECOS PAC ID: 2860801958 Enrollment ID: I20210430001152 |
| Provider Name | Vahid Osman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740264720 PECOS PAC ID: 2264409010 Enrollment ID: I20231122000791 |
| Provider Name | Katelyn R Mullett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205614500 PECOS PAC ID: 3678925161 Enrollment ID: I20240119003638 |
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