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NPI Code Detail

MEDICARE: PSYHARMONY, LLC

MEDICARE: PSYHARMONY, 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number : 1720702194
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYHARMONY, LLC
Provider Business Mailing Address
First Line : PO BOX 3373
Second Line :
City : MONUMENT
State : CO
Zip : 80132-3373
Country : US
Telephone Number : 719-413-4700
Fax Number : 719-413-4800
Provider Business Practice Location Address
First Line : 1840 WOODMOOR DR STE 100
Second Line :
City : MONUMENT
State : CO
Zip : 80132-9083
Country : US
Telephone Number : 719-413-4700
Fax Number : 719-413-4800
Authorized Official
Title or Position : PSYCHOLOGIST
Name : DR. KAREN GERSHANOV
Credential : PSYD
Telephone Number : 719-413-4700
Provider Enumeration Date : 09/29/2022
Last Update Date : 09/29/2022

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