Healthcare Provider Details

I. General information

NPI: 1215781687
Provider Name (Legal Business Name): A HEALTHY MIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E MAIN ST UNIT 117
FERNLEY NV
89408-2804
US

IV. Provider business mailing address

PO BOX 117
FERNLEY NV
89408-0117
US

V. Phone/Fax

Practice location:
  • Phone: 775-404-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BARONA
Title or Position: VICE PRESIDENT
Credential:
Phone: 702-439-8687