Provider Demographics
NPI:1437891348
Name:THE MIND STORE, LLC
Entity Type:Organization
Organization Name:THE MIND STORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HY GIA
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-209-8537
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5536
Mailing Address - Country:US
Mailing Address - Phone:303-800-6463
Mailing Address - Fax:
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 420
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5536
Practice Address - Country:US
Practice Address - Phone:303-800-6463
Practice Address - Fax:303-500-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty