Healthcare Provider Details

I. General information

NPI: 1144707878
Provider Name (Legal Business Name): DENVER WELLNESS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD STE 600
DENVER CO
80246-1239
US

IV. Provider business mailing address

PO BOX 844369
DALLAS TX
75284-4369
US

V. Phone/Fax

Practice location:
  • Phone: 720-724-3668
  • Fax:
Mailing address:
  • Phone: 720-724-3668
  • Fax: 720-598-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number52028
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEANNE THEOBALD
Title or Position: OWNER
Credential: MD
Phone: 720-724-3668