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General NPI Number Information
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NPI Number | 1184198558
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Entity Type | Organization
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Legal Business Name | INTREPID MENTAL WELLNESS, PLLC
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1776 S JACKSON ST STE 901-2
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City | DENVER
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State | CO
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Zip | 80210-3801
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Country | US
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Telephone | 719-505-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 17951 W GRANITE VIEW DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-5579
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHELSEY LAHR
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Credential | PMHNP-BC
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Telephone | 719-505-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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