Provider Demographics
NPI:1376205385
Name:NINA MINAGAWA PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:NINA MINAGAWA PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATSUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-506-3641
Mailing Address - Street 1:PO BOX 18904
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1904
Mailing Address - Country:US
Mailing Address - Phone:303-506-3641
Mailing Address - Fax:
Practice Address - Street 1:3955 E EXPOSITION AVE STE 212
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5032
Practice Address - Country:US
Practice Address - Phone:303-506-3641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000149197Medicaid