Healthcare Provider Details

I. General information

NPI: 1194473819
Provider Name (Legal Business Name): MILE HIGH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 S BELLAIRE ST STE 801
DENVER CO
80222-4307
US

IV. Provider business mailing address

2137 S LINCOLN ST
DENVER CO
80210-4408
US

V. Phone/Fax

Practice location:
  • Phone: 719-231-6427
  • Fax:
Mailing address:
  • Phone: 719-231-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY KREUZBERGER
Title or Position: OWNER/COUNSELOR
Credential: LAC, LPC
Phone: 719-231-6427