| Mind Gym LLC | |
|
8008 E Arapahoe Ct Ste 100 Centennial CO 80112-6839 | |
| (720) 593-2272 | |
| Not Available |
| Full Name | Mind Gym LLC |
|---|---|
| Speciality | Counselor |
| Location | 8008 E Arapahoe Ct Ste 100, Centennial, Colorado |
| Authorized Official Name and Position | Leroy Matticks (SOLE OWNER) |
| Authorized Official Contact | 7202900154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Gym LLC 8008 E Arapahoe Ct Ste 100 Centennial CO 80112-6839 Ph: (720) 593-2272 | Mind Gym LLC 8008 E Arapahoe Ct Ste 100 Centennial CO 80112-6839 Ph: (720) 593-2272 |
| NPI Number | 1134706229 |
|---|---|
| Provider Enumeration Date | 03/25/2021 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 7012326218 |
|---|---|
| Medicare Enrollment ID | O20210428003224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134706229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| Provider Name | Shawna M Wiant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114049103 PECOS PAC ID: 3476063009 Enrollment ID: I20250611003135 |
| Provider Name | Amir a Mahmoud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366337172 PECOS PAC ID: 3870098080 Enrollment ID: I20250926002048 |
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