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General NPI Number Information
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NPI Number | 1932522745
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Entity Type | Organization
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Legal Business Name | MIND BODY AND SPORTS CONNECTION
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 3035 LINDELL RD
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City | LAS VEGAS
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State | NV
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Zip | 89146-6818
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Country | US
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Telephone | 702-764-8878
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Fax |
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Provider Business Mailing Address
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Address Line | 3035 LINDELL RD
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City | LAS VEGAS
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State | NV
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Zip | 89146-6818
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Country | US
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Telephone | 702-764-8878
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DION A LEE
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Credential |
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Telephone | 702-764-8878
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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 | 5636-C
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License Number State | NV
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