Provider Demographics
NPI:1023741451
Name:INTRICATE MIND & BODY LLC
Entity type:Organization
Organization Name:INTRICATE MIND & BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:GAVIS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, PMHNP-BC
Authorized Official - Phone:305-924-7412
Mailing Address - Street 1:2085 SEVERN DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2247
Mailing Address - Country:US
Mailing Address - Phone:305-924-7412
Mailing Address - Fax:775-622-3177
Practice Address - Street 1:1155 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5172
Practice Address - Country:US
Practice Address - Phone:775-384-2189
Practice Address - Fax:775-384-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-04
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962093492Medicaid
NV1659815603Medicaid