Healthcare Provider Details

I. General information

NPI: 1629557509
Provider Name (Legal Business Name): BALANCED MIND CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 S JONES BLVD STE 115
LAS VEGAS NV
89146-5625
US

IV. Provider business mailing address

2780 S JONES BLVD STE 115
LAS VEGAS NV
89146-5625
US

V. Phone/Fax

Practice location:
  • Phone: 702-323-1323
  • Fax: 702-405-6036
Mailing address:
  • Phone: 702-323-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberNV20151735520
License Number StateNV

VIII. Authorized Official

Name: MR. URI BEN-SHIMON
Title or Position: MANAGER
Credential:
Phone: 702-323-1323