MEDICARE: NEW PATHWAY FOR HEALING MINDS 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	251S00000X	Community/Behavioral Health Agency	NV20181627992	NV

General Provider Information

NPI Number	:	1336621598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PATHWAY FOR HEALING MINDS LLC

Provider Business Mailing Address
First Line	:	1424 N SANDHILL RD APT 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1218
Country	:	US
Telephone Number	:	702-353-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 N SANDHILL RD APT 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1218
Country	:	US
Telephone Number	:	702-527-0660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA REEVES
Credential	:
Telephone Number	:	702-527-0660

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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