NPIMap

Organization Active NPI

Revived Minds LLC

  • Community/Behavioral Health Agency
  • Las Vegas, NV
National Provider Identifier
1033832324
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
REVIVED MINDS LLC
Practice address
6212 W Charleston Blvd # 14
Las Vegas, NV 89146-1163
Phone
(818) 232-6452
NPI assigned
Sep 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tisto Chapman Jr.
Title
Administrator
Phone
(818) 232-6452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

6212 W Charleston Blvd # 14
Las Vegas, NV 89146-1163

Mailing address

6212 W Charleston Blvd # 14
Las Vegas, NV 89146-1163
Phone (818) 232-6452

National Provider Directory

National Provider Directory

Locations

6212 W Charleston Blvd
#14
Las Vegas, NV 89146
Phone (818) 232-6452

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1033832324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6212 W CHARLESTON BLVD # 14",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461163",
            "telephone_number": "818-232-6452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6212 W CHARLESTON BLVD # 14",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461163",
            "telephone_number": "818-232-6452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVED MINDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "CHAPMAN",
        "authorized_official_first_name": "TISTO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-232-6452",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.