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NPI Code Detail

MEDICARE: MIND SPACE MENTAL HEALTH LLC

MEDICARE: MIND SPACE MENTAL HEALTH 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
1363L00000XNurse Practitioner

General Provider Information

NPI Number : 1326992348
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND SPACE MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : 9510 W SAHARA AVE STE 225
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8812
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9510 W SAHARA AVE STE 225
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-8812
Country : US
Telephone Number : 702-518-5144
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : THOMAS W FENDER III
Credential :
Telephone Number : 702-237-0216
Provider Enumeration Date : 02/25/2026
Last Update Date : 02/25/2026

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Directions to “MIND SPACE MENTAL HEALTH LLC ” Practice Location

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