Provider Demographics
NPI:1629854948
Name:MINDFUL OF LAS VEGAS LLC
Entity Type:Organization
Organization Name:MINDFUL OF LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-292-3434
Mailing Address - Street 1:1810 E SAHARA AVE STE S100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3707
Mailing Address - Country:US
Mailing Address - Phone:702-704-9611
Mailing Address - Fax:
Practice Address - Street 1:1810 E SAHARA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3707
Practice Address - Country:US
Practice Address - Phone:702-704-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty