Healthcare Provider Details

I. General information

NPI: 1093505638
Provider Name (Legal Business Name): COPPER LANTERN WELLNESS & PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 S WADSWORTH BLVD UNIT C3183
LAKEWOOD CO
80226-4328
US

IV. Provider business mailing address

1090 S WADSWORTH BLVD UNIT C3183
LAKEWOOD CO
80226-4328
US

V. Phone/Fax

Practice location:
  • Phone: 720-679-8205
  • Fax:
Mailing address:
  • Phone: 720-679-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAREY COUZELIS
Title or Position: CLINICIAN - OWNER
Credential: CNM, PMHNP-BC
Phone: 720-679-8205