Healthcare Provider Details

I. General information

NPI: 1033661210
Provider Name (Legal Business Name): EXQUISITE MIND COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7465 W LAKE MEAD BLVD STE 100
LAS VEGAS NV
89128-1033
US

IV. Provider business mailing address

7465 W LAKE MEAD BLVD STE 100
LAS VEGAS NV
89128-1033
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-6560
  • Fax:
Mailing address:
  • Phone: 702-655-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY CARSON
Title or Position: MANAGER
Credential:
Phone: 702-813-8894