Healthcare Provider Details

I. General information

NPI: 1730853672
Provider Name (Legal Business Name): MINDSIGHT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 DELMONICO DR # 215
COLORADO SPRINGS CO
80919-1899
US

IV. Provider business mailing address

6660 DELMONICO DR # 215
COLORADO SPRINGS CO
80919-1899
US

V. Phone/Fax

Practice location:
  • Phone: 402-730-8234
  • Fax:
Mailing address:
  • Phone: 402-730-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DILLON LEIGH SMALL
Title or Position: OWNER
Credential: PSYD
Phone: 402-730-8234