=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639087901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDCLIMB THERAPY & CONSULTING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3002 W ELIZABETH ST UNIT 14C
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80521-7518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-740-1737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 N GRANT ST # 10229
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-740-1737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LPC
-----------------------------------------------------
Name | EBONY JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-740-1737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------