Healthcare Provider Details

I. General information

NPI: 1134917438
Provider Name (Legal Business Name): LIFESPAN PSYCHIATRY OF COLORADO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N UNCOMPAHGRE AVE
MONTROSE CO
81401-3986
US

IV. Provider business mailing address

2140 N 12TH ST
GRAND JUNCTION CO
81501-2916
US

V. Phone/Fax

Practice location:
  • Phone: 970-579-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARRIE SHAHBAHRAMI
Title or Position: OWNER
Credential:
Phone: 970-579-0003