Provider Demographics
NPI:1346126299
Name:MIMS, NATASHA SAKURA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:SAKURA
Last Name:MIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9089 S PECOS RD STE 3600
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7186
Mailing Address - Country:US
Mailing Address - Phone:702-201-3206
Mailing Address - Fax:
Practice Address - Street 1:9089 S PECOS RD STE 3600
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7186
Practice Address - Country:US
Practice Address - Phone:702-201-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1707263918106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician