Healthcare Provider Details

I. General information

NPI: 1871178814
Provider Name (Legal Business Name): MAPLE STAR COLORADO DBA CLARVIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W CORONA AVE STE 209
PUEBLO CO
81004-1210
US

IV. Provider business mailing address

2250 S ONEIDA ST STE 200
DENVER CO
80224-2558
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-1975
  • Fax:
Mailing address:
  • Phone: 303-564-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEATHER MORRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 303-433-1975