MEDICARE: WANDERING MINDS BEHAVIORAL 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

General Provider Information

NPI Number	:	1649739384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDERING MINDS BEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	3787 TERRACE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1273
Country	:	US
Telephone Number	:	702-717-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	3787 TERRACE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-1273
Country	:	US
Telephone Number	:	702-717-0029
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARLA MARIE PARSONS
Credential	:
Telephone Number	:	702-826-8232

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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