Provider Demographics
NPI:1992491708
Name:NEURODIVERGENT MINDS
Entity type:Organization
Organization Name:NEURODIVERGENT MINDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIERSTEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIPPIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:504-234-9433
Mailing Address - Street 1:7280 BODEGA PT APT 2232
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6934
Mailing Address - Country:US
Mailing Address - Phone:504-234-9433
Mailing Address - Fax:
Practice Address - Street 1:4820 RUSINA RD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8127
Practice Address - Country:US
Practice Address - Phone:504-234-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health