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General NPI Number Information
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NPI Number | 1205526308
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Entity Type | Organization
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Legal Business Name | VISTAS PEDIATRIC AND FAMILY MENTAL WELLNESS
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 698 BRIGGS ST. SUITE 4
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City | ERIE
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State | CO
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Zip | 80516
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Country | US
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Telephone | 720-324-7158
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Fax | 833-547-1923
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Provider Business Mailing Address
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Address Line | 2038 FALCON DR
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City | LONGMONT
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State | CO
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Zip | 80503-7946
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Country | US
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Telephone | 303-945-9676
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Fax | 833-547-1923
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JENNIFER CROWE
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Credential | PMHNP-BC MSN, RN
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Telephone | 303-945-9676
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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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