Healthcare Provider Details

I. General information

NPI: 1295374031
Provider Name (Legal Business Name): MINDWORKS BEHAVIORAL HEALTH & MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 W. AZURE DR., STE. 240
LAS VEGAS NV
89130
US

IV. Provider business mailing address

7495 W. AZURE DR., STE. 240
LAS VEGAS NV
89130
US

V. Phone/Fax

Practice location:
  • Phone: 702-815-0746
  • Fax: 702-548-6891
Mailing address:
  • Phone: 702-815-0746
  • Fax: 702-548-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. HYLIDA DENISE WILLIAMS
Title or Position: OWNER
Credential:
Phone: 702-815-0746