NPIMap

Organization Active NPI

Mind Gym LLC

  • Marriage & Family Therapist
  • Westminster, CO
National Provider Identifier
1043919954
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
MIND GYM LLC
Practice address
2861 W 120TH Ave Ste 220
Westminster, CO 80234-2985
Phone
(720) 290-0154
Fax
(720) 222-5533
NPI assigned
Feb 28, 2023
Organization subpart
Yes
Parent organization
MIND GYM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Leroy Matticks
Title
Ceo
Phone
(720) 513-5092

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

2861 W 120TH Ave Ste 220
Westminster, CO 80234-2985

Mailing address

PO Box 21150
Boulder, CO 80308-4150
Phone (720) 290-0154

Other names 1

  • Mind Gym Neurofeedback Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mind Gym LLC3 organizations share this tax ID, including this one
Part of
Mind Gym LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5350 N Academy Blvd
Colorado Springs, CO 80918
Phone (719) 401-7947

Practitioners & affiliated clinicians

Practitioners 3

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": "1677542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1043919954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21150",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803084150",
            "telephone_number": "720-290-0154",
            "fax_number": "720-222-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2861 W 120TH AVE STE 220",
            "city": "WESTMINSTER",
            "state": "CO",
            "postal_code": "802342985",
            "telephone_number": "720-290-0154",
            "fax_number": "720-222-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND GYM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIND GYM LLC",
        "enumeration_date": "2023-02-28",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "MATTICKS",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "720-513-5092"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Gym Neurofeedback",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westminster, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.