Healthcare Provider Details

I. General information

NPI: 1053226092
Provider Name (Legal Business Name): LOYAL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 NIAGARA RD
MONTROSE CO
81401-5072
US

IV. Provider business mailing address

1677 NIAGARA RD
MONTROSE CO
81401-5072
US

V. Phone/Fax

Practice location:
  • Phone: 970-536-5133
  • Fax: 970-632-6153
Mailing address:
  • Phone: 970-536-5133
  • Fax: 970-632-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA PETERSON
Title or Position: OWNER
Credential: ACNP, FNP, PMHNP
Phone: 970-536-5133