=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922068931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCKY MOUNTAIN BEHAVIORAL HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3239 INDEPENDENCE RD
-----------------------------------------------------
City | CANON CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81212-9380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-275-7650
-----------------------------------------------------
Fax | 719-275-4209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3239 INDEPENDENCE RD
-----------------------------------------------------
City | CANON CITY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81212-9380
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-275-7650
-----------------------------------------------------
Fax | 719-275-4209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | LOIS R PETERSEN-KELLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-275-7650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 1063-00
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------