Healthcare Provider Details

I. General information

NPI: 1174903157
Provider Name (Legal Business Name): WELLMIND OF LITTLETON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E ARAPAHOE RD STE 104
CENTENNIAL CO
80112-1390
US

IV. Provider business mailing address

9956 W REMINGTON PL STE 114-A10
LITTLETON CO
80128-6732
US

V. Phone/Fax

Practice location:
  • Phone: 303-520-0958
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. MICHAEL MINES
Title or Position: MANAGER
Credential:
Phone: 303-520-0958