Healthcare Provider Details

I. General information

NPI: 1245666098
Provider Name (Legal Business Name): MIND OVER MATTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 NIBLICK DR
LAS VEGAS NV
89108-1113
US

IV. Provider business mailing address

916 NIBLICK DR
LAS VEGAS NV
89108-1113
US

V. Phone/Fax

Practice location:
  • Phone: 702-637-5137
  • Fax:
Mailing address:
  • Phone: 702-637-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE THOMAS
Title or Position: OWNER
Credential:
Phone: 702-637-5137