Healthcare Provider Details

I. General information

NPI: 1063050698
Provider Name (Legal Business Name): PENKATY THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 COLORADO AVE
GRAND JUNCTION CO
81501-3523
US

IV. Provider business mailing address

2890 DURANGO DR
GRAND JUNCTION CO
81503-2918
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-2948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PENKATY
Title or Position: OWNER
Credential:
Phone: 970-314-4039