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General NPI Number Information
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NPI Number | 1427298868
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Entity Type | Organization
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Legal Business Name | CENTENNIAL MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 650 EAST WALNUT, UNIT C
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City | ELIZABETH
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State | CO
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Zip | 80107
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Country | US
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Telephone | 970-522-4549
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Fax | 970-522-6898
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Provider Business Mailing Address
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Address Line | 211 W MAIN ST
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City | STERLING
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State | CO
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Zip | 80751-3168
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Country | US
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Telephone | 970-522-4549
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Fax | 970-522-6898
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Authorized Official
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Title or Position | EXECUTIVE DIRTECTOR
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Name | ELIZABETH HICKMAN
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Credential | PHD
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Telephone | 970-522-4549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 15K991
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License Number State | CO
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