Healthcare Provider Details

I. General information

NPI: 1689597700
Provider Name (Legal Business Name): HEALING GROVE INTEGRATIVE BEHAVIORAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 S YOSEMITE ST STE 201
GREENWOOD VILLAGE CO
80111-3220
US

IV. Provider business mailing address

5655 S YOSEMITE ST STE 201
GREENWOOD VILLAGE CO
80111-3220
US

V. Phone/Fax

Practice location:
  • Phone: 720-203-6266
  • Fax: 720-528-7939
Mailing address:
  • Phone: 720-203-6266
  • Fax: 720-528-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DIEM PHAN
Title or Position: CLINICAL & PRESCRIBING PSYCHOLOGIST
Credential: PHD, MSCP
Phone: 720-203-6266