MEDICARE: MINDFUL CONNECTIONS MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	103T00000X	Psychologist
3	106H00000X	Marriage & Family Therapist
4	251S00000X	Community/Behavioral Health Agency
5	261Q00000X	Clinic/Center
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891242905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL CONNECTIONS MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	719-423-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	719-423-7428
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOLOGIST
Name	:	DR. ERIKA JOHNSON
Credential	:	PSYD
Telephone Number	:	720-402-6648

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	03/05/2021

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