Provider Demographics
NPI:1376957886
Name:MIND HEART AND SOUL BEHAVIOR COUNSELING & WELLNESS GROUP
Entity Type:Organization
Organization Name:MIND HEART AND SOUL BEHAVIOR COUNSELING & WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CEDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-477-5086
Mailing Address - Street 1:1410 SANTA MARGARITA ST
Mailing Address - Street 2:UNIT H
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-2939
Mailing Address - Country:US
Mailing Address - Phone:702-477-5086
Mailing Address - Fax:
Practice Address - Street 1:1410 SANTA MARGARITA ST
Practice Address - Street 2:UNIT H
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-2939
Practice Address - Country:US
Practice Address - Phone:702-477-5086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251500000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization