MEDICARE: LOGOS THERAPEUTICS PSYCHOTHERAPY & MEDICATION MANAGEMENT, 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	:	1831863919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGOS THERAPEUTICS PSYCHOTHERAPY & MEDICATION MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	10035 E 7TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80010-3903
Country	:	US
Telephone Number	:	303-587-1865
Fax Number	:

Provider Business Practice Location Address
First Line	:	7010 BROADWAY STE 210
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-2921
Country	:	US
Telephone Number	:	303-650-1070
Fax Number	:	303-650-5970

Authorized Official
Title or Position	:	MEMBER
Name	:	BRENDA YVONNE MCCARTHY
Credential	:	NURSE PRACTITIONER
Telephone Number	:	303-587-1865

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/04/2021

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