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NPI Code Detail

MEDICARE: NEURODIVERGENT MINDS

MEDICARE: NEURODIVERGENT MINDS
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1992491708
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEURODIVERGENT MINDS
Provider Business Mailing Address
First Line : 7280 BODEGA PT APT 2232
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-6934
Country : US
Telephone Number : 504-234-9433
Fax Number :
Provider Business Practice Location Address
First Line : 4820 RUSINA RD STE A
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-8127
Country : US
Telephone Number : 504-234-9433
Fax Number :
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : KIERSTEN V SIPPIO
Credential : PSYD
Telephone Number : 504-234-9433
Provider Enumeration Date : 04/14/2023
Last Update Date : 04/14/2023

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Directions to “NEURODIVERGENT MINDS ” Practice Location

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