MEDICARE: BALANCED MIND CENTERS

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	:	1932550290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED MIND CENTERS

Provider Business Mailing Address
First Line	:	6100 EMPIRE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1451
Country	:	US
Telephone Number	:	702-409-4913
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 EMPIRE CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1451
Country	:	US
Telephone Number	:	702-409-4913
Fax Number	:

Authorized Official
Title or Position	:	COUNSELLOR
Name	:	ROBERTO CASTELLVI
Credential	:
Telephone Number	:	702-409-4913

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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