Healthcare Provider Details

I. General information

NPI: 1235882564
Provider Name (Legal Business Name): MINDFUL MINDS PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 STROH RANCH WAY STE 203
PARKER CO
80134-7507
US

IV. Provider business mailing address

16592 HIGH DESERT PL
PARKER CO
80134-3044
US

V. Phone/Fax

Practice location:
  • Phone: 720-458-5413
  • Fax: 720-815-0397
Mailing address:
  • Phone: 720-458-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DEIMYS VIGIL
Title or Position: OWNER
Credential: NP
Phone: 786-589-1291