=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235685371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDI K. COUNTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2016
-----------------------------------------------------
Last Update Date | 08/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 E SIMPSON ST
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80026-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-441-2392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 E SIMPSON ST
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80026-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-441-2392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. MINDI KAY COUNTS
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 720-441-2392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0001893
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------