Healthcare Provider Details

I. General information

NPI: 1336000595
Provider Name (Legal Business Name): MINDCARE SOLUTIONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CARSON AVE
LA JUNTA CO
81050-2751
US

IV. Provider business mailing address

PO BOX 7977
CAROL STREAM IL
60197-7977
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 330-536-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIAN NICHOLS
Title or Position: SR VP OF REVENUE OPERATIONS
Credential:
Phone: 615-334-5078