NPIMap

Organization Active NPI

Mind Body and Soul LLC

  • Professional Counselor
  • Las Vegas, NV
National Provider Identifier
1508325366
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MIND BODY AND SOUL LLC
Practice address
1405 San Juan Hills Dr Unit 105
Las Vegas, NV 89134-6390
Phone
(770) 341-4402
NPI assigned
Mar 19, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

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

Authorized official

Name
Jeffrey CarsonNPI 1801130232
Title
Ceo
Phone
(770) 364-4402

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

1405 San Juan Hills Dr Unit 105
Las Vegas, NV 89134-6390

Mailing address

1405 San Juan Hills Dr Unit 105
Las Vegas, NV 89134-6390

Other identifiers 1

IdentifierTypeStateIssuer
NV20191215058OtherNVBUSINESS LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL JEFFREYCARSON1@GMAIL.COM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1552953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1508325366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 SAN JUAN HILLS DR UNIT 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891346390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 SAN JUAN HILLS DR UNIT 105",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891346390",
            "telephone_number": "770-341-4402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND BODY AND SOUL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-19",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-364-4402"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "NV20191215058",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "JEFFREYCARSON1@GMAIL.COM",
            "affiliation": "N",
            "address_1": "1405 San Juan Hills Dr Unit 105",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891346390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Mar 19, 2019; 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.