Provider Demographics
NPI:1689129900
Name:MIND MATTERS COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:MIND MATTERS COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:THYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-622-9715
Mailing Address - Street 1:2530 ABARR DR STE 120B
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3170
Mailing Address - Country:US
Mailing Address - Phone:970-622-9715
Mailing Address - Fax:
Practice Address - Street 1:2530 ABARR DR STE 120B
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3170
Practice Address - Country:US
Practice Address - Phone:970-622-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72152338Medicaid