Healthcare Provider Details

I. General information

NPI: 1508445123
Provider Name (Legal Business Name): EMERALD ROSE COUNSELING & PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 INDEPENDENCE ST STE 225
WHEAT RIDGE CO
80033-6849
US

IV. Provider business mailing address

4891 INDEPENDENCE ST STE 225
WHEAT RIDGE CO
80033-6849
US

V. Phone/Fax

Practice location:
  • Phone: 720-779-1998
  • Fax: 720-596-5093
Mailing address:
  • Phone: 720-779-1998
  • Fax: 720-596-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMBER L GROB
Title or Position: APRN
Credential: APRN
Phone: 720-779-1998