Provider Demographics
NPI:1083271340
Name:SPIRIT & MIND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:SPIRIT & MIND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-761-6567
Mailing Address - Street 1:7455 ARROYO CROSSING PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4088
Mailing Address - Country:US
Mailing Address - Phone:702-761-6567
Mailing Address - Fax:
Practice Address - Street 1:2340 E CALVADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5821
Practice Address - Country:US
Practice Address - Phone:702-761-6567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPIRIT & MIND BEHAVIORAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health