Healthcare Provider Details

I. General information

NPI: 1174458103
Provider Name (Legal Business Name): GRAND MESA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST STE R
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 970-787-5100
  • Fax: 970-787-5100
Mailing address:
  • Phone: 970-787-5100
  • Fax: 970-787-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HOLLY SHOCKLEY
Title or Position: OWNER
Credential:
Phone: 970-787-5100