Healthcare Provider Details

I. General information

NPI: 1922994292
Provider Name (Legal Business Name): EAGLE RIVER MENTAL WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 CHAMBERS AVE UNIT 202
EAGLE CO
81631-5597
US

IV. Provider business mailing address

PO BOX 1450
EAGLE CO
81631-1450
US

V. Phone/Fax

Practice location:
  • Phone: 970-660-3403
  • Fax:
Mailing address:
  • Phone: 706-603-4039
  • Fax: 970-585-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NORWEEN WOODS
Title or Position: OWNER
Credential:
Phone: 970-585-7816