MEDICARE: MUSTARD SEEDZ 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1811850720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSTARD SEEDZ MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1500 N GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	719-414-7345
Fax Number	:	303-879-8544

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	719-414-7345
Fax Number	:	303-879-8544

Authorized Official
Title or Position	:	PMHNP
Name	:	NICOLE HUMPHREY
Credential	:	NP
Telephone Number	:	719-414-7345

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

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