Healthcare Provider Details

I. General information

NPI: 1851726079
Provider Name (Legal Business Name): CHERISH STEPHENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 S QUINTERO ST
AURORA CO
80013-3075
US

IV. Provider business mailing address

3763 S QUINTERO ST
AURORA CO
80013-3075
US

V. Phone/Fax

Practice location:
  • Phone: 720-870-6288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number283Q00000X
License Number StateCO

VIII. Authorized Official

Name: CHERISH A STEPHENS
Title or Position: MENTAL HEALTH TECH
Credential:
Phone: 720-870-6288