Healthcare Provider Details

I. General information

NPI: 1902492978
Provider Name (Legal Business Name): HEALTHY MINDS OF COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S HOWES ST # 1368
FORT COLLINS CO
80521-2700
US

IV. Provider business mailing address

PO BOX 1368
FORT COLLINS CO
80522-1368
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-5587
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL TOWE
Title or Position: COFOUNDER
Credential: PMHNP-BC
Phone: 970-310-3406