=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215781026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRAME OF MIND CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2024
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6540 S PECOS RD STE 103A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-726-8216
-----------------------------------------------------
Fax | 725-726-8633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6540 S PECOS RD STE 103A
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89120-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 725-726-8216
-----------------------------------------------------
Fax | 725-726-8633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | JAYSON AGATON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 725-726-8216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------