MEDICARE: HARVEST THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1770167470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVEST THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	1780 S BELLAIRE ST STE 801
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4328
Country	:	US
Telephone Number	:	206-539-1497
Fax Number	:	720-541-6641

Provider Business Practice Location Address
First Line	:	1780 S BELLAIRE ST STE 801
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4328
Country	:	US
Telephone Number	:	720-653-9149
Fax Number	:	720-541-6641

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLI HENDERSON
Credential	:	DMFT
Telephone Number	:	303-921-2771

Provider Enumeration Date	:	05/09/2021
Last Update Date	:	11/01/2024

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