MEDICARE: VISTAS PEDIATRIC AND FAMILY MENTAL WELLNESS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205526308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTAS PEDIATRIC AND FAMILY MENTAL WELLNESS

Provider Business Mailing Address
First Line	:	350 TERRY ST STE 200
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-5464
Country	:	US
Telephone Number	:	720-324-7158
Fax Number	:	833-547-1923

Provider Business Practice Location Address
First Line	:	698 BRIGGS ST.
Second Line	:	SUITE 4
City	:	ERIE
State	:	CO
Zip	:	80516
Country	:	US
Telephone Number	:	720-324-7158
Fax Number	:	833-547-1923

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JENNIFER CROWE
Credential	:	PMHNP-BC MSN, RN
Telephone Number	:	303-945-9676

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	04/21/2026

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Directions to “VISTAS PEDIATRIC AND FAMILY MENTAL WELLNESS ” Practice Location

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