Provider Demographics
NPI:1922853738
Name:MIRACLE MINDS THERAPY LLC
Entity type:Organization
Organization Name:MIRACLE MINDS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRCHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-280-7203
Mailing Address - Street 1:4485 S BUFFALO DR # C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5006
Mailing Address - Country:US
Mailing Address - Phone:702-280-7203
Mailing Address - Fax:702-450-1891
Practice Address - Street 1:4485 S BUFFALO DR # C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-5006
Practice Address - Country:US
Practice Address - Phone:702-280-7203
Practice Address - Fax:702-450-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty