Healthcare Provider Details

I. General information

NPI: 1467273300
Provider Name (Legal Business Name): COLORFUL MINDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ANTLER DR STE 201
CASPER WY
82601-1749
US

IV. Provider business mailing address

701 ANTLER DR STE 201
CASPER WY
82601-1749
US

V. Phone/Fax

Practice location:
  • Phone: 307-797-2398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK BERGH
Title or Position: OWNER
Credential: LPC
Phone: 307-797-2398