MEDICARE: FAMILY TREE PSYCHIATRIC CARE

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073392650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TREE PSYCHIATRIC CARE

Provider Business Mailing Address
First Line	:	111 E 3RD ST STE 221
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2346
Country	:	US
Telephone Number	:	970-781-2040
Fax Number	:	970-781-2041

Provider Business Practice Location Address
First Line	:	111 E 3RD ST STE 221
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2346
Country	:	US
Telephone Number	:	970-781-2040
Fax Number	:	970-781-2041

Authorized Official
Title or Position	:	OWNER
Name	:	LYNN AMES
Credential	:	PMHNP-BC
Telephone Number	:	970-781-2040

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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