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General NPI Number Information
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NPI Number | 1285247486
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Entity Type | Organization
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Legal Business Name | MASTERMIND CLINIC PLLC
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 5225 N ACADEMY BLVD # 305
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4000
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Country | US
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Telephone | 719-644-6463
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Fax | 844-579-0123
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Provider Business Mailing Address
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Address Line | 5225 N ACADEMY BLVD # 305
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-4000
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Country | US
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Telephone | 719-644-6463
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Fax | 844-579-0123
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Authorized Official
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Title or Position | PMHNP-BC
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Name | JENNIE STORMES
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Credential | MSN APN RXN
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Telephone | 719-644-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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