Healthcare Provider Details

I. General information

NPI: 1427870195
Provider Name (Legal Business Name): HUMMINGBIRD BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11813 ROAD 27.1
DOLORES CO
81323-9247
US

IV. Provider business mailing address

11813 ROAD 27.1
DOLORES CO
81323-9247
US

V. Phone/Fax

Practice location:
  • Phone: 970-779-0699
  • Fax:
Mailing address:
  • Phone: 970-779-0699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERALYNN VALLERY
Title or Position: OWNER
Credential: MS BCBA
Phone: 970-779-0699