Healthcare Provider Details

I. General information

NPI: 1760854442
Provider Name (Legal Business Name): SONDERMIND PROVIDER NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date: 04/02/2023
Reactivation Date: 04/04/2023

III. Provider practice location address

720 S COLORADO BLVD PH NORTH
DENVER CO
80246-1904
US

IV. Provider business mailing address

1099 18TH ST STE 2350
DENVER CO
80202-1936
US

V. Phone/Fax

Practice location:
  • Phone: 844-843-7279
  • Fax: 844-416-0584
Mailing address:
  • Phone: 844-843-7279
  • Fax: 720-293-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARMEN FELDMAN
Title or Position: DIRECTOR
Credential:
Phone: 844-843-7279