Healthcare Provider Details

I. General information

NPI: 1366099020
Provider Name (Legal Business Name): MILE HIGH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N SCOTTSDALE RD STE 104-6
SCOTTSDALE AZ
85254-4057
US

IV. Provider business mailing address

15355 E COLFAX AVE UNIT 111717
AURORA CO
80042-1975
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 720-367-5067
Mailing address:
  • Phone: 720-507-4779
  • Fax: 720-367-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KEITH CHISM
Title or Position: CEO/PSYCHIATRIC DIRECTOR
Credential:
Phone: 720-507-4779