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General NPI Number Information
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NPI Number | 1376957886
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Entity Type | Organization
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Legal Business Name | MIND HEART AND SOUL BEHAVIOR COUNSELING & WELLNESS GROUP
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 1410 SANTA MARGARITA ST UNIT H
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City | LAS VEGAS
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State | NV
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Zip | 89146-2939
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Country | US
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Telephone | 702-477-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 1410 SANTA MARGARITA ST UNIT H
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City | LAS VEGAS
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State | NV
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Zip | 89146-2939
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Country | US
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Telephone | 702-477-5086
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CEDRA PERRY
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Credential |
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Telephone | 702-477-5086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 251500000X
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License Number State | NV
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