Healthcare Provider Details

I. General information

NPI: 1912793894
Provider Name (Legal Business Name): MILE HIGH PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 HURON ST STE 209
NORTHGLENN CO
80234-4378
US

IV. Provider business mailing address

17667 E KETTLE PL
CENTENNIAL CO
80016-1878
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 833-941-5047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA MALTESE
Title or Position: DIR. OR REVENUE ANALYTICS & STRATEG
Credential:
Phone: 720-355-3299