Provider Demographics
NPI:1407290067
Name:BEAUTIFUL MINDS BEHAVIORAL HEALTH FACILITY LLC
Entity Type:Organization
Organization Name:BEAUTIFUL MINDS BEHAVIORAL HEALTH FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LA-SHANDIA
Authorized Official - Middle Name:DANELL
Authorized Official - Last Name:BINION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-813-5413
Mailing Address - Street 1:4332 TWIN PEAKS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0111
Mailing Address - Country:US
Mailing Address - Phone:702-813-5413
Mailing Address - Fax:
Practice Address - Street 1:4332 TWIN PEAKS DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0111
Practice Address - Country:US
Practice Address - Phone:702-813-5413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20131247167101YM0800X, 103TB0200X, 103TM1800X
1041C0700X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty