MEDICARE: BEAUTIFUL MINDS BEHAVIORAL HEALTH FACILITY 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	101YM0800X	Mental Health Counselor	NV20131247167	NV
2	103TM1800X	Intellectual & Developmental Disabilities Psychologist	NV20131247167	NV
3	1041C0700X	Clinical Social Worker
4	251B00000X	Case Management Agency
5	251S00000X	Community/Behavioral Health Agency
6	103TB0200X	Cognitive & Behavioral Psychologist	NV20131247167	NV

General Provider Information

NPI Number	:	1407290067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MINDS BEHAVIORAL HEALTH FACILITY LLC

Provider Business Mailing Address
First Line	:	4332 TWIN PEAKS DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0111
Country	:	US
Telephone Number	:	702-813-5413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4332 TWIN PEAKS DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0111
Country	:	US
Telephone Number	:	702-813-5413
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LA-SHANDIA DANELL BINION
Credential	:
Telephone Number	:	702-813-5413

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	12/17/2020

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