Healthcare Provider Details

I. General information

NPI: 1205526308
Provider Name (Legal Business Name): VISTAS PEDIATRIC AND FAMILY MENTAL WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRY ST STE 200
LONGMONT CO
80501-5464
US

IV. Provider business mailing address

350 TERRY ST STE 200
LONGMONT CO
80501-5464
US

V. Phone/Fax

Practice location:
  • Phone: 720-324-7158
  • Fax: 833-547-1923
Mailing address:
  • Phone: 720-324-7158
  • Fax: 833-547-1923

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: JENNIFER JUNE CROWE
Title or Position: OWNER/PROVIDER
Credential:
Phone: 720-324-7158