MEDICARE: MINDCORPS HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TC0700X	Clinical Psychologist
3	101YM0800X	Mental Health Counselor
4	101YA0400X	Addiction (Substance Use Disorder) Counselor
5	104100000X	Social Worker
6	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477412716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDCORPS HEALTH LLC

Provider Business Mailing Address
First Line	:	1500 N GRANT ST # 7348
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-880-6664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST # 7348
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-880-6664
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. KAMARON TILLMAN
Credential	:	LCSW, LAC
Telephone Number	:	720-880-6664

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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