Healthcare Provider Details

I. General information

NPI: 1205466497
Provider Name (Legal Business Name): HUMMINGBIRD PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 WALNUT ST STE F
FORT COLLINS CO
80524-4441
US

IV. Provider business mailing address

204 WALNUT ST STE F
FORT COLLINS CO
80524-4441
US

V. Phone/Fax

Practice location:
  • Phone: 802-316-8116
  • Fax: 608-360-9104
Mailing address:
  • Phone: 802-316-8116
  • Fax: 608-360-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DUSTIN DIPPEN
Title or Position: OWNER
Credential: MD
Phone: 802-316-8116