Provider Demographics
NPI:1003435371
Name:CLEAR MINDS FAMILY CENTER GEORGIA LLC
Entity Type:Organization
Organization Name:CLEAR MINDS FAMILY CENTER GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NASTAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-463-4000
Mailing Address - Street 1:220 MILINANE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2550
Mailing Address - Country:US
Mailing Address - Phone:702-463-4000
Mailing Address - Fax:702-463-4460
Practice Address - Street 1:1050 CROWN POINTE PKWY
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7707
Practice Address - Country:US
Practice Address - Phone:702-463-4000
Practice Address - Fax:702-463-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty