Healthcare Provider Details

I. General information

NPI: 1437893906
Provider Name (Legal Business Name): OWL AND EAGLE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 E PROGRESS PL STE 100
GREENWOOD VILLAGE CO
80111-2130
US

IV. Provider business mailing address

430 INDIANA ST STE 100
GOLDEN CO
80401-5012
US

V. Phone/Fax

Practice location:
  • Phone: 303-736-9697
  • Fax: 720-306-5464
Mailing address:
  • Phone: 303-736-9697
  • Fax: 720-306-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL FRALLER
Title or Position: CFO
Credential:
Phone: 303-736-9697