Provider Demographics
NPI:1467963397
Name:CARE OF THE MIND LLC
Entity type:Organization
Organization Name:CARE OF THE MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:LORENZA
Authorized Official - Middle Name:PEREZ
Authorized Official - Last Name:FRIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:970-302-1746
Mailing Address - Street 1:2601 S LEMAY AVE STE 7134
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2295
Mailing Address - Country:US
Mailing Address - Phone:970-302-1746
Mailing Address - Fax:
Practice Address - Street 1:2601 S LEMAY AVE STE 7134
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2295
Practice Address - Country:US
Practice Address - Phone:970-302-1746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0993018-NP363LP0808X
CO261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153897Medicaid