Healthcare Provider Details

I. General information

NPI: 1639350879
Provider Name (Legal Business Name): JEFFERSON CENTER FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 12/04/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31207 KEATS WAY STE 202
EVERGREEN CO
80439-2220
US

IV. Provider business mailing address

4851 INDEPENDENCE ST STE 200
WHEAT RIDGE CO
80033-6712
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5300
  • Fax: 303-432-5350
Mailing address:
  • Phone: 303-425-0300
  • Fax: 303-432-5071

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 TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID A GOFF
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 303-432-5164