MEDICARE: MOUNTAIN MIND, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0993185	CO

General Provider Information

NPI Number	:	1861917056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN MIND, LLC

Provider Business Mailing Address
First Line	:	1863 WAZEE ST APT 1G
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1248
Country	:	US
Telephone Number	:	720-788-6068
Fax Number	:	719-207-4464

Provider Business Practice Location Address
First Line	:	1863 WAZEE ST APT 1G
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1248
Country	:	US
Telephone Number	:	303-808-8816
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH A YORK
Credential	:	MSN, PMHNP-BC, APRN
Telephone Number	:	720-788-6068

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	03/11/2025

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