Healthcare Provider Details

I. General information

NPI: 1467503995
Provider Name (Legal Business Name): JEFFERSON CENTER FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 W COLFAX AVE
LAKEWOOD CO
80215-3918
US

IV. Provider business mailing address

4851 INDEPENDENCE ST SUITE 200
WHEAT RIDGE CO
80033-6715
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5200
  • Fax: 303-432-5260
Mailing address:
  • Phone: 303-432-5200
  • Fax: 303-432-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2818
License Number StateCO

VIII. Authorized Official

Name: MS. M. CHRISTINE KEHRES
Title or Position: INTENSIVE CASE MANAGER
Credential: MA, LPC
Phone: 303-432-5200