Organization
REVIVED MINDS LLC
Active
Organization
REVIVED MINDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TISTO CHAPMAN JR. (ADMINISTRATOR)
(818) 232-6452
Entity
Organization
Contact information
Practice address
6212 W CHARLESTON BLVD # 14, LAS VEGAS, NV 89146-1163
(818) 232-6452
Mailing address
6212 W CHARLESTON BLVD # 14, LAS VEGAS, NV 89146-1163
(818) 232-6452
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/21/2022
Last updated
04/10/2024
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