| Mind Reneural Llc | |
|
5040 Corporate Plaza Dr Ste 7g Colorado Springs CO 80919-6100 | |
| (928) 853-5019 | |
| Not Available |
| Full Name | Mind Reneural Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5040 Corporate Plaza Dr Ste 7g, Colorado Springs, Colorado |
| Authorized Official Name and Position | Zachary L Guzman (OWNER) |
| Authorized Official Contact | 9288535019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Reneural Llc 5040 Corporate Plaza Dr Ste 7g Colorado Springs CO 80919-6100 Ph: (928) 853-5019 | Mind Reneural Llc 5040 Corporate Plaza Dr Ste 7g Colorado Springs CO 80919-6100 Ph: (928) 853-5019 |
| NPI Number | 1639728595 |
|---|---|
| Provider Enumeration Date | 09/04/2019 |
| Last Update Date | 09/04/2019 |
| Medicare PECOS PAC ID | 2668842303 |
|---|---|
| Medicare Enrollment ID | O20221221001895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639728595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Zachary L Guzman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700244084 PECOS PAC ID: 3577933217 Enrollment ID: I20221221002001 |
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