Healthcare Provider Details

I. General information

NPI: 1447242383
Provider Name (Legal Business Name): MENTAL HEALTH CENTER OF DENVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 E DICKENSON PL
DENVER CO
80222
US

IV. Provider business mailing address

4141 E DICKENSON PL
DENVER CO
80222-6012
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-6500
  • Fax: 303-782-0916
Mailing address:
  • Phone: 303-504-6500
  • Fax: 303-782-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number150466
License Number StateCO

VIII. Authorized Official

Name: DR. ROBERT CARL CLARK
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 303-504-6655