Healthcare Provider Details

I. General information

NPI: 1336957901
Provider Name (Legal Business Name): SUNFLOWER MOUNTAIN MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 EAGLERIDGE BLVD, STE 140
PUEBLO CO
81008-2354
US

IV. Provider business mailing address

805 EAGLERIDGE BLVD, STE 140
PUEBLO CO
81008-2354
US

V. Phone/Fax

Practice location:
  • Phone: 719-679-5022
  • Fax: 719-888-1673
Mailing address:
  • Phone: 719-679-5022
  • Fax: 719-888-1673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BLUBAUGH
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-679-5022