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NPI Code Detail

MEDICARE: PENKATY THERAPY SERVICES

MEDICARE: PENKATY THERAPY SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1063050698
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENKATY THERAPY SERVICES
Provider Business Mailing Address
First Line : 2890 DURANGO DR
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81503-2918
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1170 COLORADO AVE
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81501-3523
Country : US
Telephone Number : 970-241-2948
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MICHAEL PENKATY
Credential :
Telephone Number : 970-314-4039
Provider Enumeration Date : 12/13/2019
Last Update Date : 12/13/2019

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Directions to “PENKATY THERAPY SERVICES ” Practice Location

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