Provider Demographics
NPI:1295408789
Name:MIND SPA PC
Entity Type:Organization
Organization Name:MIND SPA PC
Other - Org Name:MIND SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:509-385-4800
Mailing Address - Street 1:5340 S QUEBEC ST # 230S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1909
Mailing Address - Country:US
Mailing Address - Phone:509-385-4800
Mailing Address - Fax:
Practice Address - Street 1:5340 S QUEBEC ST # 230S
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1909
Practice Address - Country:US
Practice Address - Phone:509-385-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health