Healthcare Provider Details

I. General information

NPI: 1922521509
Provider Name (Legal Business Name): WEST CENTRAL MENTAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 TABOR STREET #110 & 112
BUENA VISTA CO
81211-9158
US

IV. Provider business mailing address

3225 INDEPENDENCE RD
CANON CITY CO
81212-9380
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-6502
  • Fax:
Mailing address:
  • Phone: 719-275-2351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1668-03
License Number StateCO

VIII. Authorized Official

Name: MANDY JO KAISNER
Title or Position: CEO
Credential: LPC
Phone: 719-275-2351