Healthcare Provider Details

I. General information

NPI: 1396493367
Provider Name (Legal Business Name): AUTUMN SUN MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4328 N COUNTY ROAD 19
FORT COLLINS CO
80524-9748
US

IV. Provider business mailing address

PO BOX 719
LAPORTE CO
80535-0719
US

V. Phone/Fax

Practice location:
  • Phone: 970-645-6228
  • Fax: 970-233-9830
Mailing address:
  • Phone: 970-645-6228
  • 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
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA TURK
Title or Position: OWNER/PROVIDER
Credential: PMHNP, FNP
Phone: 970-645-6228