Healthcare Provider Details

I. General information

NPI: 1255075040
Provider Name (Legal Business Name): 24LINCOLN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 3RD ST STE 400
MONUMENT CO
80132-8179
US

IV. Provider business mailing address

15740 PAIUTE CIR
MONUMENT CO
80132-6092
US

V. Phone/Fax

Practice location:
  • Phone: 719-433-5710
  • Fax:
Mailing address:
  • Phone: 719-433-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SARA PETRIE
Title or Position: OWNER
Credential:
Phone: 719-433-5710