Healthcare Provider Details

I. General information

NPI: 1336731983
Provider Name (Legal Business Name): ALLIANCE MENTAL HEALTH, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
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

3723 GREENVILLE AVE STE 50904
DALLAS TX
75206-5311
US

V. Phone/Fax

Practice location:
  • Phone: 918-608-0380
  • Fax:
Mailing address:
  • Phone: 918-608-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD LOBATO
Title or Position: CEO
Credential:
Phone: 918-608-0380