Provider Demographics
NPI:1205519535
Name:MINDWELL COUNSELING & CRISIS SERVICES, LLC
Entity type:Organization
Organization Name:MINDWELL COUNSELING & CRISIS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORDICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-358-4894
Mailing Address - Street 1:2810 W CHARLESTON BLVD STE 74
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1910
Mailing Address - Country:US
Mailing Address - Phone:725-291-2700
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD STE 74
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:725-291-2700
Practice Address - Fax:725-291-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty