Healthcare Provider Details

I. General information

NPI: 1528208428
Provider Name (Legal Business Name): CENTENNIAL MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 W 2ND ST
WRAY CO
80758-1009
US

IV. Provider business mailing address

211 W MAIN ST
STERLING CO
80751-3168
US

V. Phone/Fax

Practice location:
  • Phone: 970-522-4549
  • Fax: 970-522-6898
Mailing address:
  • Phone: 970-522-4549
  • Fax: 970-522-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number150153
License Number StateCO

VIII. Authorized Official

Name: ELIZABETH HICKMAN
Title or Position: EXECUTIE DIRECTOR
Credential: PHD
Phone: 970-522-4549