Healthcare Provider Details

I. General information

NPI: 1811077753
Provider Name (Legal Business Name): BEHAVIORAL HEALTH CENTER OF EXCELLENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 W COLORADO AVE
COLORADO SPRINGS CO
80904-3325
US

IV. Provider business mailing address

2212 W COLORADO AVE
COLORADO SPRINGS CO
80904-3325
US

V. Phone/Fax

Practice location:
  • Phone: 719-226-0659
  • Fax: 719-226-0753
Mailing address:
  • Phone: 719-226-0659
  • Fax: 719-226-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number81050
License Number StateCO

VIII. Authorized Official

Name: EVELYN D BALERIA
Title or Position: OWNER
Credential: APRN, BC, CNS, RXN
Phone: 719-226-0659