Healthcare Provider Details

I. General information

NPI: 1073328704
Provider Name (Legal Business Name): CHANGING MINDS PSYCHIATRY - RENO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 HUBBARD WAY STE B
RENO NV
89502-3777
US

IV. Provider business mailing address

PO BOX 752003
LAS VEGAS NV
89136-2003
US

V. Phone/Fax

Practice location:
  • Phone: 833-575-4012
  • Fax: 702-405-6066
Mailing address:
  • Phone: 702-405-8088
  • Fax: 702-405-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BROWN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 833-575-4012