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General NPI Number Information
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NPI Number | 1902763790
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Entity Type | Organization
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Legal Business Name | MENDING MINDS LLC
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Dates
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Enumeration Date | 01/05/2026
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 3097 E WARM SPRINGS RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89120-3757
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Country | US
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Telephone | 702-291-7482
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Fax | 702-718-6718
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Provider Business Mailing Address
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Address Line | 3097 E WARM SPRINGS RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89120-3757
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Country | US
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Telephone | 702-291-7482
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Fax | 702-718-6718
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON FORD
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Credential | LADC
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Telephone | 702-291-7482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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