Provider Demographics
NPI:1649750217
Name:HEALTHY MINDS THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:HEALTHY MINDS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESSENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-205-7501
Mailing Address - Street 1:3670 N RANCHO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3192
Mailing Address - Country:US
Mailing Address - Phone:702-205-7501
Mailing Address - Fax:702-432-6464
Practice Address - Street 1:3670 N RANCHO DR STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3192
Practice Address - Country:US
Practice Address - Phone:702-205-7501
Practice Address - Fax:702-432-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health