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General NPI Number Information
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NPI Number | 1023627734
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Entity Type | Organization
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Legal Business Name | CHANGING MINDS PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 2960 W HORIZON RIDGE PKWY
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City | HENDERSON
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State | NV
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Zip | 89052-4666
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Country | US
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Telephone | 702-405-8088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 752003
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City | LAS VEGAS
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State | NV
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Zip | 89136-2003
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Country | US
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Telephone | 702-405-8088
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | JAMIE BROWN
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Credential |
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Telephone | 702-405-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number |
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License Number State |
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