Healthcare Provider Details

I. General information

NPI: 1306679634
Provider Name (Legal Business Name): FIDDLERS GREEN PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 S FIDDLERS GREEN CIR STE 250
GREENWOOD VILLAGE CO
80111-5075
US

IV. Provider business mailing address

3101 HIGHWAY 207
ROGERSVILLE AL
35652-4313
US

V. Phone/Fax

Practice location:
  • Phone: 720-823-7846
  • Fax:
Mailing address:
  • Phone: 720-823-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH DEAK
Title or Position: OWNER
Credential: PMHNP
Phone: 720-823-7846