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General NPI Number Information
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NPI Number | 1609690197
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Entity Type | Organization
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Legal Business Name | NORTHWIND HOLISTIC PSYCHIATRY PLLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 212 WASHINGTON ST STE F
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City | MONUMENT
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State | CO
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Zip | 80132-9173
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Country | US
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Telephone | 320-500-2024
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Fax | 320-244-7958
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Provider Business Mailing Address
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Address Line | 212 WASHINGTON ST STE F
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City | MONUMENT
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State | CO
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Zip | 80132-9173
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Country | US
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Telephone | 320-500-2024
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Fax | 320-244-7958
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KIMBERLY SMITH
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Credential |
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Telephone | 405-984-7174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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