Provider Demographics
NPI:1356026454
Name:ASCENDING MINDS LV
Entity type:Organization
Organization Name:ASCENDING MINDS LV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYDIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-517-9485
Mailing Address - Street 1:5510 S FORT APACHE RD STE 458
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5510 S FORT APACHE RD STE 458
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7700
Practice Address - Country:US
Practice Address - Phone:347-517-9485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health