NPIMap

Organization Active NPI

Rom 12-2 Counseling

Doing business as Mind Renewal Behavioral Health Services

  • Professional Counselor
  • Colorado Springs, CO
National Provider Identifier
1275060386
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
5586 Issued in CO
Legal business name
ROM 12-2 COUNSELING
Doing business as
Mind Renewal Behavioral Health Services
Practice address
660 Southpointe CT Ste 200
Colorado Springs, CO 80906-3874
Phone
(719) 465-2582
Fax
(719) 465-2643
NPI assigned
May 19, 2017
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ROM 12-2 COUNSELINGAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Mr. Carlos Villafan, LPCNPI 1174713325
Title
Owner
Phone
(719) 465-2582

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 5586 CO Primary

Addresses

Primary practice location

660 Southpointe CT Ste 200
Colorado Springs, CO 80906-3874

Mailing address

660 Southpointe CT Ste 200
Colorado Springs, CO 80906-3874
Phone (719) 465-2582

Other identifiers 2

IdentifierTypeStateIssuer
671490MedicaidCO
1174713325OtherCOINDIVIDUAL NPI

Other names 1

  • Mind Renewal Behavioral Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240326002465 CO Part B Supplier - Clinic/Group Practice 0042657009 Receives reassigned benefits from 3 practitioners
Practice locations: Colorado Springs, CO

National Provider Directory

National Provider Directory
Part of
Rom 12-2 Counseling

Locations

125 N Parkside Dr
Ste 204
Colorado Springs, CO 80909
Phone (719) 465-2582

660 Southpointe Ct
Ste 200
Colorado Springs, CO 80906
Phone (719) 465-2582

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1275060386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 SOUTHPOINTE CT STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063874",
            "telephone_number": "719-465-2582",
            "fax_number": "719-465-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 SOUTHPOINTE CT STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063874",
            "telephone_number": "719-465-2582",
            "fax_number": "719-465-2643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROM 12-2 COUNSELING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROM 12-2 COUNSELING",
        "enumeration_date": "2017-05-19",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "VILLAFAN",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-465-2582",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CO",
            "license": "5586",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "671490",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1174713325",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mind Renewal Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.