Healthcare Provider Details

I. General information

NPI: 1811850720
Provider Name (Legal Business Name): MUSTARD SEEDZ MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST
DENVER CO
80203-1859
US

IV. Provider business mailing address

1500 N GRANT ST
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 719-414-7345
  • Fax: 303-879-8544
Mailing address:
  • Phone: 719-414-7345
  • Fax: 303-879-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE HUMPHREY
Title or Position: PMHNP
Credential: NP
Phone: 719-414-7345