Healthcare Provider Details

I. General information

NPI: 1760928766
Provider Name (Legal Business Name): MILE HIGH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 E 4TH AVE STE 2-126
AURORA CO
80011-8717
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL K CHISM
Title or Position: OWNER
Credential:
Phone: 720-507-4779