Healthcare Provider Details

I. General information

NPI: 1477412716
Provider Name (Legal Business Name): MINDCORPS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST # 7348
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST # 7348
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 720-880-6664
  • Fax:
Mailing address:
  • Phone: 720-880-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. KAMARON TILLMAN
Title or Position: CLINICAL DIRECTOR
Credential: LCSW, LAC
Phone: 720-880-6664