Healthcare Provider Details

I. General information

NPI: 1134908015
Provider Name (Legal Business Name): MINDCHECK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 HIGHWAY 95 STE 120
BULLHEAD CITY AZ
86442-4336
US

IV. Provider business mailing address

3640 HIGHWAY 95 STE 120
BULLHEAD CITY AZ
86442-4336
US

V. Phone/Fax

Practice location:
  • Phone: 928-862-8689
  • Fax:
Mailing address:
  • Phone: 928-862-8689
  • Fax: 928-420-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAWNA ROEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 928-862-8689