Healthcare Provider Details

I. General information

NPI: 1962313221
Provider Name (Legal Business Name): MIND HAVEN BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 LA REINA CIR
LAS VEGAS NV
89130-5101
US

IV. Provider business mailing address

4405 LA REINA CIR
LAS VEGAS NV
89130-5101
US

V. Phone/Fax

Practice location:
  • Phone: 702-502-5957
  • Fax:
Mailing address:
  • Phone: 702-502-5957
  • 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

VIII. Authorized Official

Name: DIANA ROSA FERRA MENDEZ
Title or Position: OWNER
Credential: TECH
Phone: 702-502-5957