Healthcare Provider Details

I. General information

NPI: 1750613915
Provider Name (Legal Business Name): OUTPATIENT BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST UNIT 9
DENVER CO
80204-4507
US

IV. Provider business mailing address

777 BANNOCK ST UNIT 9
DENVER CO
80204-4507
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-5706
  • Fax: 303-436-5071
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number276400000X
License Number StateCO

VIII. Authorized Official

Name: JONNA LEE HENKEL
Title or Position: THERAPEUTIC CASE WORKER
Credential: MA, CAC III
Phone: 303-436-5706