Healthcare Provider Details

I. General information

NPI: 1568018695
Provider Name (Legal Business Name): MILE HIGH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 POST OAK PLACE DR STE 110
HOUSTON TX
77027-3105
US

IV. Provider business mailing address

15355 E COLFAX AVE UNIT 111717
AURORA CO
80042-1975
US

V. Phone/Fax

Practice location:
  • Phone: 346-308-8919
  • Fax: 720-367-5067
Mailing address:
  • Phone: 720-507-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KEITH CHISM
Title or Position: CEO PSYCHIATRIC DIRECTOR
Credential: PMHNP-BC
Phone: 720-507-4779