MEDICARE: SERENITY PEAKS, LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1154955391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY PEAKS, LLC

Provider Business Mailing Address
First Line	:	3024 BIG BIRD AVE
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-4100
Country	:	US
Telephone Number	:	970-623-1857
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 SORREL ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7850
Country	:	US
Telephone Number	:	970-623-1857
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LPC
Name	:	HOLLIE DEANN SMITH
Credential	:	LPC
Telephone Number	:	970-623-1857

Provider Enumeration Date	:	02/26/2020
Last Update Date	:	04/05/2022

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Directions to “SERENITY PEAKS, LLC ” Practice Location

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