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General NPI Number Information
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NPI Number | 1831915958
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Entity Type | Organization
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Legal Business Name | LIFESPAN PSYCHIATRY OF COLORADO
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 637 NORTH AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7513
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Country | US
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Telephone | 970-579-0003
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Fax | 970-433-7671
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Provider Business Mailing Address
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Address Line | 2140 N 12TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2916
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Country | US
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Telephone | 970-579-0003
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Fax | 970-433-7671
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Authorized Official
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Title or Position | OWNER
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Name | CARRIE SHAHBAHRAMI
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Credential |
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Telephone | 970-579-0003
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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