Healthcare Provider Details

I. General information

NPI: 1639098197
Provider Name (Legal Business Name): MAITRI PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 N SPEER BLVD
DENVER CO
80211-4225
US

IV. Provider business mailing address

2598 JOLIET ST
AURORA CO
80010-1360
US

V. Phone/Fax

Practice location:
  • Phone: 612-804-0263
  • Fax:
Mailing address:
  • Phone: 612-804-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEELY MORTENSON
Title or Position: FOUNDER/CLINICAL DIRECTOR
Credential: LMFT
Phone: 612-804-0263