MEDICARE: THE VARIEGATED MIND COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1457220519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VARIEGATED MIND COUNSELING LLC

Provider Business Mailing Address
First Line	:	343 W DRAKE RD STE 275
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-682-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	343 W DRAKE RD STE 275
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6317
Country	:	US
Telephone Number	:	970-682-3331
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CARTER HOLMES
Credential	:	MA, LPC
Telephone Number	:	970-682-3331

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	12/02/2025

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