MEDICARE: CLOVER MENTAL HEALTH CLINIC 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1780565150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER MENTAL HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	2120 BLAKE ST APT 428
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 BLAKE ST APT 428
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-3080
Country	:	US
Telephone Number	:	413-313-8317
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAINT ANDRE ELIASSAINT
Credential	:
Telephone Number	:	720-335-5768

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	12/08/2025

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