# MIND GYM LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIND GYM LLC
- **Other names:** Mind Gym Neurofeedback
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043919954
- **Legal business name:** MIND GYM LLC
- **Authorized official:** LEROY MATTICKS (CEO)
- **Authorized official phone:** (720) 513-5092

## Contact information

- **Practice address:** 2861 W 120TH AVE STE 220, WESTMINSTER, CO 80234-2985
- **Practice address phone:** (720) 290-0154
- **Practice address fax:** (720) 222-5533
- **Mailing address:** PO BOX 21150, BOULDER, CO 80308-4150
- **Mailing address phone:** (720) 290-0154
- **Mailing address fax:** (720) 222-5533

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 02/28/2023
- **Last updated:** 02/28/2023