| Intentional Living Academy | |
|
801 S Rancho Dr Ste E3a Las Vegas NV 89106-3812 | |
| (702) 620-9354 | |
| (702) 819-9516 |
| Full Name | Intentional Living Academy |
|---|---|
| Speciality | Social Worker |
| Location | 801 S Rancho Dr Ste E3a, Las Vegas, Nevada |
| Authorized Official Name and Position | Kasia Caldwell (CEO) |
| Authorized Official Contact | 7026209354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Living Academy 801 S Rancho Dr Ste E3a Las Vegas NV 89106-3812 Ph: (702) 620-9354 | Intentional Living Academy 801 S Rancho Dr Ste E3a Las Vegas NV 89106-3812 Ph: (702) 620-9354 |
| NPI Number | 1063015949 |
|---|---|
| Provider Enumeration Date | 11/20/2020 |
| Last Update Date | 07/27/2024 |
| Certification Date | 07/27/2024 |
| Medicare PECOS PAC ID | 8426463589 |
|---|---|
| Medicare Enrollment ID | O20210223001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063015949 | NPI | - | NPPES |
| 8349-C | Other | NV | STATE OF NV BOARD OF EXAMINERS FOR SOCIAL WORKERS |
| 6925313-3501 | Other | UT | STATE OF UTAH DEPARTMENT OF COMMERCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Kasia Marie Caldwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528575271 PECOS PAC ID: 2365876174 Enrollment ID: I20200103001634 |
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