Mindgym Neurofeedback LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MINDGYM NEUROFEEDBACK LLC

Practice address

1123 E Broadwing LN Apt 107
Cottonwood Heights, UT 84121-7628

Phone

(720) 290-0154

NPI assigned

Jun 27, 2025

Organization subpart

No

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

Authorized official

Name

Leroy Matticks

Title

Owner

Phone

(720) 513-5092

Specialties & licenses 1

Addresses

Other names 1

• Mind Gym Neurofeedback Other name

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Practitioners 1

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

• Jessica Jo Stenquist, TRS, CTRS, MSW, LCSW

  • Clinical Social Worker
  • Kanab, UT
  • NPI 1821546300
  Medicare reassignment NPD

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

{
    "created_epoch": "1750982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763164800000",
    "number": "1013805860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8008 E ARAPAHOE CT STE 100",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801126839",
            "telephone_number": "720-290-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 E BROADWING LN APT 107",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "841217628",
            "telephone_number": "720-290-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDGYM NEUROFEEDBACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-27",
        "last_updated": "2025-11-15",
        "certification_date": "2025-11-15",
        "status": "A",
        "authorized_official_last_name": "MATTICKS",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-513-5092"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Gym Neurofeedback",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Caden George Miller
• Cheyenne Kathryn Miller
• Katrina Holgate Miller, PH.D
• McKay Dianne Miller
• Daniel G Mills, MPT
• Emily W. Miro, MD
• Aubrey Moedl
• Jennifer Michelle Moleni, LCSW
• Momentum Chiropractic LLC
• Marette Monson, LCSW

• Mental Health Counselor in Cottonwood Heights, UT
• Providers in Cottonwood Heights, UT by specialty
• Mental Health Counselor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.