Provider Demographics
NPI:1336858281
Name:A MINDFUL CHANGE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:A MINDFUL CHANGE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:CARPLUK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCSW
Authorized Official - Phone:702-930-4126
Mailing Address - Street 1:916 NEVADA WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-2300
Mailing Address - Country:US
Mailing Address - Phone:702-930-4126
Mailing Address - Fax:702-441-7021
Practice Address - Street 1:916 NEVADA WAY STE 5
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2300
Practice Address - Country:US
Practice Address - Phone:702-930-4126
Practice Address - Fax:702-441-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250003704Medicaid