Mind Spa LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

MIND SPA LLC

Practice address

6303 E Dakota Ave
Denver, CO 80224-1246

Phone

(413) 205-8665

NPI assigned

May 24, 2021

Organization subpart

No

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

Authorized official

Name

Sam Jeffrey Peterson, MBA

Title

Director of Business Development

Phone

(509) 385-4800

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1841865656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3295 BLAKE ST APT 205",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802052469",
            "telephone_number": "509-385-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6303 E DAKOTA AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802241246",
            "telephone_number": "413-205-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND SPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "509-385-4800",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Denver, CO
• Mental Health Clinic/Center (Including Community Mental Health Center) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.