Healthcare Provider Details

I. General information

NPI: 1467963397
Provider Name (Legal Business Name): CARE OF THE MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S LEMAY AVE STE 7134
FORT COLLINS CO
80525-2295
US

IV. Provider business mailing address

2601 S LEMAY AVE STE 7134
FORT COLLINS CO
80525-2295
US

V. Phone/Fax

Practice location:
  • Phone: 970-302-1746
  • Fax:
Mailing address:
  • Phone: 970-302-1746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0993018-NP
License Number StateCO

VIII. Authorized Official

Name: LORENZA PEREZ FRIAS
Title or Position: PSYCHIATRIC MENTAL HEALTH NP
Credential: PMHNP-BC
Phone: 970-302-1746