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General NPI Number Information
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NPI Number | 1780496059
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Entity Type | Organization
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Legal Business Name | MEDICINE PARK MENTAL HEALTH
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 2922 EVERGREEN PKWY STE 207
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City | EVERGREEN
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State | CO
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Zip | 80439-7915
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Country | US
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Telephone | 719-257-3709
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Fax |
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Provider Business Mailing Address
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Address Line | 30238 CARRIAGE LOOP DR
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City | EVERGREEN
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State | CO
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Zip | 80439-8560
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Country | US
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Telephone | 720-237-3720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLINE JOURNEYCAKE
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Credential | MS, APN, PMHNP
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Telephone | 720-237-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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