Provider Demographics
NPI:1245937507
Name:UNIQUE MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:UNIQUE MENTAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:O
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-000-0000
Mailing Address - Street 1:1515 E TROPICANA AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6542
Mailing Address - Country:US
Mailing Address - Phone:702-702-1731
Mailing Address - Fax:
Practice Address - Street 1:1515 E TROPICANA AVE STE 345
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6542
Practice Address - Country:US
Practice Address - Phone:702-702-1731
Practice Address - Fax:702-979-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2105098334Medicaid