Healthcare Provider Details

I. General information

NPI: 1861342008
Provider Name (Legal Business Name): A CLEAR MIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 COLUMBIA DR
PUEBLO CO
81005-3279
US

IV. Provider business mailing address

2027 COLUMBIA DR
PUEBLO CO
81005-3279
US

V. Phone/Fax

Practice location:
  • Phone: 719-766-5363
  • Fax:
Mailing address:
  • Phone: 719-766-5363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAWN KOURY
Title or Position: OWNER
Credential:
Phone: 719-766-5363