MEDICARE: MIND POWER BEHAVIORAL SERVICES 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	363L00000X	Nurse Practitioner		NV
2	208D00000X	General Practice Physician		NV

General Provider Information

NPI Number	:	1851871768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND POWER BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	4570 S EASTERN AVE STE 28
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6183
Country	:	US
Telephone Number	:	702-476-3345
Fax Number	:	702-920-8596

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123
Country	:	US
Telephone Number	:	818-932-4684
Fax Number	:	888-277-1901

Authorized Official
Title or Position	:	CEO
Name	:	CRISTINE HERNANDEZ
Credential	:
Telephone Number	:	818-932-4684

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	06/24/2025

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