Healthcare Provider Details

I. General information

NPI: 1932083250
Provider Name (Legal Business Name): HEARTLIGHT FAMILY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 E BAYAUD AVE STE 333
DENVER CO
80209-2929
US

IV. Provider business mailing address

1001 S PERRY ST STE 104B
CASTLE ROCK CO
80104-1950
US

V. Phone/Fax

Practice location:
  • Phone: 720-485-3178
  • Fax:
Mailing address:
  • Phone: 720-485-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENT HERRON
Title or Position: OWNER
Credential:
Phone: 303-249-0908