Provider Demographics
NPI:1235882564
Name:MINDFUL MINDS PSYCHIATRY LLC
Entity Type:Organization
Organization Name:MINDFUL MINDS PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEIMYS
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:786-589-1291
Mailing Address - Street 1:16592 HIGH DESERT PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3044
Mailing Address - Country:US
Mailing Address - Phone:720-458-5413
Mailing Address - Fax:
Practice Address - Street 1:12760 STROH RANCH WAY STE 203
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7507
Practice Address - Country:US
Practice Address - Phone:720-458-5413
Practice Address - Fax:720-815-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0995555-NPOtherCOLORADO LICENSE