Healthcare Provider Details

I. General information

NPI: 1396681516
Provider Name (Legal Business Name): CHANGING MINDS PSYCHIATRY LA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13360 COURSEY BLVD STE B
BATON ROUGE LA
70816-5025
US

IV. Provider business mailing address

PO BOX 752003
LAS VEGAS NV
89136-2003
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-8088
  • Fax: 702-405-8088
Mailing address:
  • Phone: 702-405-8088
  • Fax: 702-405-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BROWN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 702-405-8088