Healthcare Provider Details

I. General information

NPI: 1023917853
Provider Name (Legal Business Name): SPANDA MIND BODY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 RALSTON RD
ARVADA CO
80002-2431
US

IV. Provider business mailing address

4695 GARLAND ST
WHEAT RIDGE CO
80033-3019
US

V. Phone/Fax

Practice location:
  • Phone: 720-484-8342
  • Fax:
Mailing address:
  • Phone: 720-984-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY DERUS
Title or Position: OWNER & PSYCHOTHERAPIST
Credential: LPC
Phone: 720-984-6694