MEDICARE: MONROE MENTAL HEALTH, 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	251S00000X	Community/Behavioral Health Agency	0003556	CO

General Provider Information

NPI Number	:	1740687516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	2750 ELK PARK RD
Second Line	:
City	:	LARKSPUR
State	:	CO
Zip	:	80118-6613
Country	:	US
Telephone Number	:	303-548-4236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 W COLORADO AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3837
Country	:	US
Telephone Number	:	303-548-4236
Fax Number	:	888-505-5816

Authorized Official
Title or Position	:	SOLE PROVIDER AND CEO
Name	:	DR. DANA LYNN MONROE
Credential	:	PSY.D
Telephone Number	:	303-548-4236

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	03/01/2022

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