Provider Demographics
NPI:1700622909
Name:INNOVATIVE MINDS COUNSELING LLC
Entity type:Organization
Organization Name:INNOVATIVE MINDS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA CPC
Authorized Official - Phone:512-368-6408
Mailing Address - Street 1:455 DORCHESTER BEND AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5607
Mailing Address - Country:US
Mailing Address - Phone:512-368-6408
Mailing Address - Fax:
Practice Address - Street 1:455 DORCHESTER BEND AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5607
Practice Address - Country:US
Practice Address - Phone:512-368-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty