Healthcare Provider Details

I. General information

NPI: 1679135263
Provider Name (Legal Business Name): MIND FITNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BELLEVIEW AVE
CRESTED BUTTE CO
81224
US

IV. Provider business mailing address

PO BOX 1397
CRESTED BUTTE CO
81224-1397
US

V. Phone/Fax

Practice location:
  • Phone: 970-658-3350
  • Fax:
Mailing address:
  • Phone: 970-596-5269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA A SCALES
Title or Position: OWNER
Credential:
Phone: 970-658-3350