Healthcare Provider Details

I. General information

NPI: 1053110577
Provider Name (Legal Business Name): PRISM MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

IV. Provider business mailing address

5335 W 48TH AVE STE 500
DENVER CO
80212-2732
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-2173
  • Fax:
Mailing address:
  • Phone: 303-351-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA JOHNSON
Title or Position: NURSE PRACTITIONER
Credential: MSN, FNP-C, PMHP-BC
Phone: 303-351-2173