Healthcare Provider Details

I. General information

NPI: 1841109758
Provider Name (Legal Business Name): COLORADO SPRINGS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 JICARILLA DR
COLORADO SPRINGS CO
80908-3366
US

IV. Provider business mailing address

6720 JICARILLA DR
COLORADO SPRINGS CO
80908-3366
US

V. Phone/Fax

Practice location:
  • Phone: 719-347-8224
  • Fax:
Mailing address:
  • Phone: 719-347-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR CAVENDER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 719-347-8224