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General NPI Number Information
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NPI Number | 1144465642
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Entity Type | Organization
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Legal Business Name | DEPRESSION & BIPOLAR CLINIC OF COLORADO, PLLC.
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 400 E HORSETOOTH RD SUITE 300
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City | FORT COLLINS
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State | CO
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Zip | 80525-3189
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Country | US
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Telephone | 970-484-5625
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Fax | 970-493-5131
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Provider Business Mailing Address
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Address Line | 400 E HORSETOOTH RD SUITE 300
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City | FORT COLLINS
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State | CO
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Zip | 80525-3189
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Country | US
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Telephone | 970-484-5625
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Fax | 970-493-5131
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. TAMMAS FREDERICK KELLY
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Credential | M.D.
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Telephone | 970-484-5625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 30397
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License Number State | CO
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