Provider Demographics
NPI:1730735028
Name:MINER, MANDY LYNN (CAC/CAS, QMHA-II, TH)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LYNN
Last Name:MINER
Suffix:
Gender:F
Credentials:CAC/CAS, QMHA-II, TH
Other - Prefix:MS
Other - First Name:MANDY
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA-II, CADC-I, THW
Mailing Address - Street 1:3400 W 16TH ST STE P
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6871
Mailing Address - Country:US
Mailing Address - Phone:970-978-4386
Mailing Address - Fax:970-888-3175
Practice Address - Street 1:3400 W 16TH ST STE P
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6871
Practice Address - Country:US
Practice Address - Phone:970-978-4386
Practice Address - Fax:970-888-3175
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24CRM3244175T00000X
AZ390200000X
OR24-06-11159101YA0400X
OR24-QMHA-II-000264101YM0800X
COACC.0021373101YA0400X
OK316485171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator