Healthcare Provider Details

I. General information

NPI: 1407290067
Provider Name (Legal Business Name): BEAUTIFUL MINDS BEHAVIORAL HEALTH FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 TWIN PEAKS DR
NORTH LAS VEGAS NV
89032-0111
US

IV. Provider business mailing address

4332 TWIN PEAKS DR
NORTH LAS VEGAS NV
89032-0111
US

V. Phone/Fax

Practice location:
  • Phone: 702-813-5413
  • Fax:
Mailing address:
  • Phone: 702-813-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNV20131247167
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberNV20131247167
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberNV20131247167
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LA-SHANDIA DANELL BINION
Title or Position: MANAGER
Credential:
Phone: 702-813-5413