NPIMap

Organization Active NPI

Mind Reneural LLC

  • Clinical Social Worker
  • Colorado Springs, CO
National Provider Identifier
1639728595
Registry record updated Sep 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
MIND RENEURAL LLC
Practice address
5040 Corporate Plaza Dr Ste 7G
Colorado Springs, CO 80919-6100
Phone
(928) 853-5019
NPI assigned
Sep 4, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2019

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

Authorized official

Name
Mr. Zachary L Guzman, LCSWNPI 1700244084
Title
Owner
Phone
(928) 853-5019

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
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5040 Corporate Plaza Dr Ste 7G
Colorado Springs, CO 80919-6100

Mailing address

5040 Corporate Plaza Dr Ste 7G
Colorado Springs, CO 80919-6100
Phone (928) 853-5019

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221221001895 CO Part B Supplier - Clinic/Group Practice 2668842303 Receives reassigned benefits from 1 practitioner
Practice locations: Colorado Springs, CO

National Provider Directory

National Provider Directory
Tax ID family
Mind Reneural LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

5040 Corporate Plaza Dr
Colorado Springs, CO 80919
Phone (719) 249-7896

Practitioners & affiliated clinicians

Practitioners 7

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": "1567555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567555200000",
    "number": "1639728595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5040 CORPORATE PLAZA DR STE 7G",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809196100",
            "telephone_number": "928-853-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5040 CORPORATE PLAZA DR STE 7G",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809196100",
            "telephone_number": "928-853-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND RENEURAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-04",
        "last_updated": "2019-09-04",
        "status": "A",
        "authorized_official_last_name": "GUZMAN",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-853-5019",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 4, 2019; 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.