Healthcare Provider Details

I. General information

NPI: 1265361026
Provider Name (Legal Business Name): MAVERICK MIND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 MONTEBELLO DR STE 400
COLORADO SPRINGS CO
80918-7224
US

IV. Provider business mailing address

13395 VOYAGER PKWY SUITE 130 PMB 2026
COLORADO SPRINGS CO
80921
US

V. Phone/Fax

Practice location:
  • Phone: 719-988-3843
  • Fax:
Mailing address:
  • Phone: 719-988-3843
  • Fax: 719-888-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOELLE JOSEPHINA BAILEY
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 719-988-3843