Healthcare Provider Details

I. General information

NPI: 1770247702
Provider Name (Legal Business Name): ALLIANCE MENTAL HEALTH - COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 S LEMAY AVE UNIT 3
FORT COLLINS CO
80525-2247
US

IV. Provider business mailing address

PO BOX 12192
DENVER CO
80212-0192
US

V. Phone/Fax

Practice location:
  • Phone: 303-928-1051
  • Fax:
Mailing address:
  • Phone: 303-928-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RON LOBATO
Title or Position: CEO
Credential:
Phone: 303-928-1051