MEDICARE: INTRICATE MIND & BODY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1023741451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRICATE MIND & BODY LLC

Provider Business Mailing Address
First Line	:	2085 SEVERN DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-2247
Country	:	US
Telephone Number	:	305-924-7412
Fax Number	:	775-622-3177

Provider Business Practice Location Address
First Line	:	1155 W 4TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-5172
Country	:	US
Telephone Number	:	775-384-2189
Fax Number	:	775-384-2254

Authorized Official
Title or Position	:	PSYCHIATRIC NURSE PRACTITIONER
Name	:	MR. DENIS GAVIS WILLIAMS
Credential	:	APRN-CNP, PMHNP-BC
Telephone Number	:	305-924-7412

Provider Enumeration Date	:	07/04/2022
Last Update Date	:	05/29/2025

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