Organization
THE MIND STORE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HY GIA YOUNG PARK MD (MANAGING PARTNER)
(720) 209-8537
Entity
Organization
Contact information
Practice address
10099 RIDGEGATE PKWY STE 420, LONE TREE, CO 80124-5536
(303) 800-6463
(303) 500-6585
Mailing address
10099 RIDGEGATE PKWY STE 420, LONE TREE, CO 80124-5536
(303) 800-6463
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
04/11/2022
Last updated
01/31/2024
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