MEDICARE: BODY AND MIND BEHAVIORAL SERVICES 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194501817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY AND MIND BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	9171 MOUNT WILSON ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-6154
Country	:	US
Telephone Number	:	702-748-9642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6284 S RAINBOW BLVD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3245
Country	:	US
Telephone Number	:	702-748-9642
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	MICHELLE LAJOICE
Credential	:	LCPC
Telephone Number	:	702-748-9642

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	09/07/2023

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