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General NPI Number Information
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NPI Number | 1629594312
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Entity Type | Organization
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Legal Business Name | MINDS OVER MATTER
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 3690 S EASTERN AVE
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City | LAS VEGAS
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State | NV
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Zip | 89169-3300
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Country | US
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Telephone | 702-832-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 3260 FOUNTAIN FALLS WAY UNIT 1097
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-2241
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Country | US
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Telephone | 702-826-8109
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Fax |
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Authorized Official
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Title or Position | CO-C.E.O.
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Name | MRS. STACEY WATSON
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Credential |
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Telephone | 702-826-8109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20171475544
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License Number State | NV
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