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NPI Code Detail

MEDICARE: MINDCOLOR AUTISM LLC

MEDICARE: MINDCOLOR AUTISM LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1376253716
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDCOLOR AUTISM LLC
Provider Business Mailing Address
First Line : 224 W 35TH ST STE 500
Second Line :
City : NEW YORK
State : NY
Zip : 10001-2538
Country : US
Telephone Number : 833-646-3222
Fax Number : 833-646-3222
Provider Business Practice Location Address
First Line : 295 INTERLOCKEN BLVD STE 250
Second Line :
City : BROOMFIELD
State : CO
Zip : 80021-8040
Country : US
Telephone Number : 833-646-3222
Fax Number : 833-646-3222
Authorized Official
Title or Position : CO-FOUNDER
Name : HENG LI
Credential :
Telephone Number : 833-646-3222
Provider Enumeration Date : 11/28/2022
Last Update Date : 11/28/2022

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Directions to “MINDCOLOR AUTISM LLC ” Practice Location

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