Healthcare Provider Details

I. General information

NPI: 1376205385
Provider Name (Legal Business Name): NINA MINAGAWA PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E EXPOSITION AVE STE 212
DENVER CO
80209-5032
US

IV. Provider business mailing address

PO BOX 18904
BOULDER CO
80308-1904
US

V. Phone/Fax

Practice location:
  • Phone: 303-506-3641
  • Fax:
Mailing address:
  • Phone: 303-506-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NATSUMI MINAGAWA
Title or Position: OWNER
Credential: PSY.D
Phone: 303-506-3641