Provider Demographics
NPI:1821700428
Name:MASTERMIND BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:MASTERMIND BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SALAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-323-8082
Mailing Address - Street 1:2801 YOUNGFIELD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2202
Mailing Address - Country:US
Mailing Address - Phone:720-323-8082
Mailing Address - Fax:
Practice Address - Street 1:2801 YOUNGFIELD ST STE 202
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2202
Practice Address - Country:US
Practice Address - Phone:720-323-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health