Provider Demographics
NPI:1801454673
Name:EVOLVING MINDS BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:EVOLVING MINDS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOLLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STILES-BRADSHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-318-7544
Mailing Address - Street 1:1771 E FLAMINGO RD STE 106A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5156
Mailing Address - Country:US
Mailing Address - Phone:702-318-7544
Mailing Address - Fax:702-478-6012
Practice Address - Street 1:1771 E FLAMINGO RD STE 106A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5156
Practice Address - Country:US
Practice Address - Phone:702-318-7544
Practice Address - Fax:702-478-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty