Healthcare Provider Details

I. General information

NPI: 1104669589
Provider Name (Legal Business Name): BJERUM THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8838 CULEBRA ST
ARVADA CO
80007-7334
US

IV. Provider business mailing address

1905 SHERMAN STREET STE 200 #1199
DENVER CO
80203
US

V. Phone/Fax

Practice location:
  • Phone: 316-772-6320
  • Fax:
Mailing address:
  • Phone: 316-772-6320
  • Fax: 719-259-3140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN M BJERUM
Title or Position: PRESIDENT
Credential: LSCSW, LCAC, LCSW
Phone: 316-772-6320