Healthcare Provider Details

I. General information

NPI: 1194428268
Provider Name (Legal Business Name): SMC MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 COMMERCE CENTER DR STE 220
COLORADO SPRINGS CO
80919-2631
US

IV. Provider business mailing address

7222 COMMERCE CENTER DR STE 220
COLORADO SPRINGS CO
80919-2631
US

V. Phone/Fax

Practice location:
  • Phone: 719-283-3584
  • Fax: 719-400-1977
Mailing address:
  • Phone: 719-283-3584
  • Fax: 719-400-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SYRETTA MCGRAW
Title or Position: OWNER/NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 719-412-1400