Healthcare Provider Details

I. General information

NPI: 1942056080
Provider Name (Legal Business Name): TREE OF LIFE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 S PERRY ST STE 140
CASTLE ROCK CO
80104-1990
US

IV. Provider business mailing address

3449 VAUGHN VIEW DR
PUEBLO CO
81005-9750
US

V. Phone/Fax

Practice location:
  • Phone: 719-417-5754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BENALLY-ROSS
Title or Position: OWNER
Credential: PMHNP
Phone: 719-439-3641