Healthcare Provider Details

I. General information

NPI: 1336858281
Provider Name (Legal Business Name): A MINDFUL CHANGE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 03/11/2023
Certification Date: 03/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NEVADA WAY STE 5
BOULDER CITY NV
89005-2300
US

IV. Provider business mailing address

916 NEVADA WAY STE 5
BOULDER CITY NV
89005-2300
US

V. Phone/Fax

Practice location:
  • Phone: 702-930-4126
  • Fax: 702-441-7021
Mailing address:
  • Phone: 702-930-4126
  • Fax: 702-441-7021

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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNDI EVETTE CARPLUK
Title or Position: OWNER
Credential: LMSW, LCSW
Phone: 702-930-4126