Healthcare Provider Details

I. General information

NPI: 1619403631
Provider Name (Legal Business Name): MINDWISE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 W MAIN STREET SUITE 105
NEW CASTLE CO
81647
US

IV. Provider business mailing address

PO BOX 556
NEW CASTLE CO
81647-0556
US

V. Phone/Fax

Practice location:
  • Phone: 970-319-1999
  • Fax: 970-319-1999
Mailing address:
  • Phone: 970-319-1999
  • Fax: 970-550-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001316
License Number StateCO

VIII. Authorized Official

Name: MARY ELIZABETH BOWLES
Title or Position: PRESIDENT, THERAPIST
Credential: LMFT, RRT, MIACN
Phone: 970-319-1999