Provider Demographics
NPI:1700213857
Name:DISCOVERY MIND AND WELLNESS
Entity Type:Organization
Organization Name:DISCOVERY MIND AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT SUPERVISER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-968-9372
Mailing Address - Street 1:659 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2725
Mailing Address - Country:US
Mailing Address - Phone:310-591-0123
Mailing Address - Fax:
Practice Address - Street 1:659 AVENUE H
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2725
Practice Address - Country:US
Practice Address - Phone:310-591-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization