Provider Demographics
NPI:1134706229
Name:MIND GYM LLC
Entity type:Organization
Organization Name:MIND GYM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-290-0154
Mailing Address - Street 1:8008 E ARAPAHOE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6839
Mailing Address - Country:US
Mailing Address - Phone:720-593-2272
Mailing Address - Fax:
Practice Address - Street 1:8008 E ARAPAHOE CT STE 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6839
Practice Address - Country:US
Practice Address - Phone:720-593-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty