Healthcare Provider Details

I. General information

NPI: 1982533840
Provider Name (Legal Business Name): RISING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11650 MARTIN LUTHER KING BLVD APT 325
DENVER CO
80238-4264
US

IV. Provider business mailing address

4952 E 62ND AVE UNIT A-3167
COMMERCE CITY CO
80022-3254
US

V. Phone/Fax

Practice location:
  • Phone: 303-999-5196
  • Fax:
Mailing address:
  • Phone: 303-999-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAZMYN RAE GRAY
Title or Position: CHIEF ADVANCEMENT OFFICER
Credential: CPFS
Phone: 303-999-5196