MEDICARE: PSYCH ON HEELS

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	173198	CO

General Provider Information

NPI Number	:	1427284470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCH ON HEELS

Provider Business Mailing Address
First Line	:	2754 COMPASS DR
Second Line	:	SUITE 300
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81506-8714
Country	:	US
Telephone Number	:	970-254-1686
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 KOKOPELLI BLVD
Second Line	:
City	:	FRUITA
State	:	CO
Zip	:	81521-6305
Country	:	US
Telephone Number	:	970-254-1686
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRIE GLASSMEYER
Credential	:
Telephone Number	:	970-254-1686

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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Directions to “PSYCH ON HEELS ” Practice Location

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