Healthcare Provider Details

I. General information

NPI: 1285247486
Provider Name (Legal Business Name): MASTERMIND CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 N ACADEMY BLVD # 305
COLORADO SPRINGS CO
80918-4000
US

IV. Provider business mailing address

5225 N ACADEMY BLVD # 305
COLORADO SPRINGS CO
80918-4000
US

V. Phone/Fax

Practice location:
  • Phone: 719-644-6463
  • Fax: 844-579-0123
Mailing address:
  • Phone: 719-644-6463
  • Fax: 844-579-0123

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: JENNIE STORMES
Title or Position: PMHNP-BC
Credential: MSN APN RXN
Phone: 719-644-6463