| Mind Renewal Behavioral Health Services | |
|
660 Southpointe Ct Ste 200 Colorado Springs CO 80906-3874 | |
| (719) 465-2582 | |
| (719) 465-2643 |
| Full Name | Mind Renewal Behavioral Health Services |
|---|---|
| Speciality | Counselor |
| Location | 660 Southpointe Ct Ste 200, Colorado Springs, Colorado |
| Authorized Official Name and Position | Carlos Villafan (OWNER) |
| Authorized Official Contact | 7194652582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Renewal Behavioral Health Services 660 Southpointe Ct Ste 200 Colorado Springs CO 80906-3874 Ph: (719) 465-2582 | Mind Renewal Behavioral Health Services 660 Southpointe Ct Ste 200 Colorado Springs CO 80906-3874 Ph: (719) 465-2582 |
| NPI Number | 1275060386 |
|---|---|
| Provider Enumeration Date | 05/19/2017 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/26/2024 |
| Medicare PECOS PAC ID | 0042657009 |
|---|---|
| Medicare Enrollment ID | O20240326002465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275060386 | NPI | - | NPPES |
| 1174713325 | Other | CO | INDIVIDUAL NPI |
| 671490 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5586 (Colorado) | Primary |
| Provider Name | Carlos E Villafan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174713325 PECOS PAC ID: 1951748912 Enrollment ID: I20240326002696 |
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