MEDICARE: GRAND MESA THERAPY PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1174458103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND MESA THERAPY PLLC

Provider Business Mailing Address
First Line	:	1500 N GRANT ST STE R
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	970-787-5100
Fax Number	:	970-787-5100

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST STE R
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	970-787-5100
Fax Number	:	970-787-5100

Authorized Official
Title or Position	:	OWNER
Name	:	HOLLY SHOCKLEY
Credential	:
Telephone Number	:	970-787-5100

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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