Healthcare Provider Details

I. General information

NPI: 1639460793
Provider Name (Legal Business Name): MENTAL HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 IRIS AVE
BOULDER CO
80304-2296
US

IV. Provider business mailing address

1333 IRIS AVE
BOULDER CO
80304-2296
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-1665
  • Fax:
Mailing address:
  • Phone: 303-447-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier07051999
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MS. BARBARA RYAN
Title or Position: CEO
Credential: PH.D
Phone: 303-443-8500