Healthcare Provider Details

I. General information

NPI: 1184497638
Provider Name (Legal Business Name): MOUNTAIN WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 S VINE ST STE 1059
CENTENNIAL CO
80122-3171
US

IV. Provider business mailing address

6767 S VINE ST
CENTENNIAL CO
80122-3171
US

V. Phone/Fax

Practice location:
  • Phone: 719-789-4515
  • Fax: 704-498-4954
Mailing address:
  • Phone: 719-789-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMISON STRAHAN
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 719-789-4515