Provider Demographics
NPI:1194501817
Name:BODY AND MIND BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:BODY AND MIND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJOICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:702-748-9642
Mailing Address - Street 1:9171 MOUNT WILSON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6154
Mailing Address - Country:US
Mailing Address - Phone:702-748-9642
Mailing Address - Fax:
Practice Address - Street 1:6284 S RAINBOW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3245
Practice Address - Country:US
Practice Address - Phone:702-748-9642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty