MEDICARE: INSPIRING MINDS BEHAVIORAL SERVICES

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	NV20161570483	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972054567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSPIRING MINDS BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	3621 KINGFISHERS CATCH AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 KINGFISHERS CATCH AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2347
Country	:	US
Telephone Number	:	702-321-8984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRACEE THOMAS
Credential	:
Telephone Number	:	702-321-8984

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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