Provider Demographics
NPI:1760061691
Name:MINDSHIFT PSYCHIATRY PLLC
Entity type:Organization
Organization Name:MINDSHIFT PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSCELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-388-2991
Mailing Address - Street 1:10161 PARK RUN DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8872
Mailing Address - Country:US
Mailing Address - Phone:702-748-9726
Mailing Address - Fax:
Practice Address - Street 1:1811 S RAINBOW BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-748-9726
Practice Address - Fax:702-608-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty