MEDICARE: BUILDING & ADVANCING MINDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1013517580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUILDING & ADVANCING MINDS, LLC

Provider Business Mailing Address
First Line	:	3465 W CRAIG RD STE C
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5121
Country	:	US
Telephone Number	:	702-530-2749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3465 W CRAIG RD STE C
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-5121
Country	:	US
Telephone Number	:	702-530-2749
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CHERYL EVERAGE
Credential	:	LADC-S, LADC, MAC
Telephone Number	:	702-530-2749

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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