Healthcare Provider Details

I. General information

NPI: 1073165296
Provider Name (Legal Business Name): NORTHERN HORIZON BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 06/23/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N RUTHERFORD AVE
JOHNSTOWN CO
80534-8639
US

IV. Provider business mailing address

138 E 4TH ST STE 8
LOVELAND CO
80537-5502
US

V. Phone/Fax

Practice location:
  • Phone: 970-619-1920
  • Fax: 970-449-7519
Mailing address:
  • Phone: 970-619-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BROOKE JOHNSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 970-534-1967