MEDICARE: MASTERMIND COMMUNITY RESOLUTIONS

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	:	1518694629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERMIND COMMUNITY RESOLUTIONS

Provider Business Mailing Address
First Line	:	7152 POLITA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7152 POLITA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-7153
Country	:	US
Telephone Number	:	702-439-7519
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	SHANA D WILLIAMS
Credential	:
Telephone Number	:	702-439-7519

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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Directions to “MASTERMIND COMMUNITY RESOLUTIONS ” Practice Location

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