Healthcare Provider Details

I. General information

NPI: 1932748779
Provider Name (Legal Business Name): MINDWORKS MENTAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 TIMBERLAKE DR.
LAS VEGAS NV
89115
US

IV. Provider business mailing address

3830 TIMBERLAKE DR.
LAS VEGAS NV
89115
US

V. Phone/Fax

Practice location:
  • Phone: 702-308-2866
  • Fax:
Mailing address:
  • Phone: 702-308-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MRS. HYLIDA DENISE WILLIAMS
Title or Position: CEO/OWNER
Credential:
Phone: 702-308-2866