Healthcare Provider Details

I. General information

NPI: 1851871768
Provider Name (Legal Business Name): MIND POWER BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 S EASTERN AVE STE 150
LAS VEGAS NV
89123
US

IV. Provider business mailing address

4570 S EASTERN AVE STE 28
LAS VEGAS NV
89119-6183
US

V. Phone/Fax

Practice location:
  • Phone: 818-932-4684
  • Fax: 888-277-1901
Mailing address:
  • Phone: 702-476-3345
  • Fax: 702-920-8596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNV

VIII. Authorized Official

Name: CRISTINE HERNANDEZ
Title or Position: CEO
Credential:
Phone: 818-932-4684