MEDICARE: COLORADO INNOVATIVE SERVICES 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417607334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO INNOVATIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	7550 E 53RD PL UNIT 5788
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80217-7430
Country	:	US
Telephone Number	:	720-654-3322
Fax Number	:

Provider Business Practice Location Address
First Line	:	5888 BEELER CT
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2376
Country	:	US
Telephone Number	:	720-654-3322
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEREK KILMURRAY
Credential	:	MBA
Telephone Number	:	720-654-3322

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	11/02/2023

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