Healthcare Provider Details

I. General information

NPI: 1063559334
Provider Name (Legal Business Name): BETH BALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8671 S. QUEBEC ST. STE 200
HIGHLAND RANCH CO
80130
US

IV. Provider business mailing address

P.O. BOX 400
COTOPAXI CO
81223-0400
US

V. Phone/Fax

Practice location:
  • Phone: 888-852-6672
  • Fax: 305-891-4228
Mailing address:
  • Phone: 719-285-5121
  • Fax: 719-218-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number45766
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: