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NPI Code Detail

MEDICARE: GREAT MIND COUNSELING AND WELLNESS CENTER LLC

MEDICARE: GREAT MIND COUNSELING AND WELLNESS CENTER 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
1363LP2300XPrimary Care Nurse Practitioner
2106S00000XBehavior Technician
3106H00000XMarriage & Family Therapist
4101YM0800XMental Health Counselor
52084P0800XPsychiatry Physician
62084B0040XBehavioral Neurology & Neuropsychiatry Physician
7104100000XSocial Worker
8101YP2500XProfessional Counselor
9251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1437668985
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT MIND COUNSELING AND WELLNESS CENTER LLC
Provider Business Mailing Address
First Line : 1600 E DESERT INN RD STE 104
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-2505
Country : US
Telephone Number : 702-208-2194
Fax Number :
Provider Business Practice Location Address
First Line : 1600 E DESERT INN RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-2505
Country : US
Telephone Number : 702-208-2194
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MAIMOUNA ROSE CANTRALL
Credential :
Telephone Number : 702-208-2194
Provider Enumeration Date : 09/28/2017
Last Update Date : 02/24/2026

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