Provider Demographics
NPI:1578962924
Name:HEALTHY MIND BODY & SPIRIT
Entity Type:Organization
Organization Name:HEALTHY MIND BODY & SPIRIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSR/BST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:702-836-3442
Mailing Address - Street 1:1580 E DESERT INN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-2548
Mailing Address - Country:US
Mailing Address - Phone:702-836-3443
Mailing Address - Fax:702-836-9367
Practice Address - Street 1:1580 E DESERT INN RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-2548
Practice Address - Country:US
Practice Address - Phone:702-836-3443
Practice Address - Fax:702-836-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health