MEDICARE: EMPOWERING MINDS L.L.C.

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	NV20121072886	NV

General Provider Information

NPI Number	:	1689947905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERING MINDS L.L.C.

Provider Business Mailing Address
First Line	:	9145 HOMBARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2612
Country	:	US
Telephone Number	:	702-245-5988
Fax Number	:

Provider Business Practice Location Address
First Line	:	9145 HOMBARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2612
Country	:	US
Telephone Number	:	702-245-5988
Fax Number	:

Authorized Official
Title or Position	:	QMHA
Name	:	BRANDON CLEVELAND
Credential	:
Telephone Number	:	702-245-9883

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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