MEDICARE: HERMITS POINT MEDICINE, 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	103T00000X	Psychologist	NLC.0010464	CO
2	225700000X	Massage Therapist	MT.0001747	CO
3	171100000X	Acupuncturist	ACU.0002125	CO

General Provider Information

NPI Number	:	1942727201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERMITS POINT MEDICINE, LLC

Provider Business Mailing Address
First Line	:	6705 S PENROSE CT
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80122-1255
Country	:	US
Telephone Number	:	720-629-4211
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 S VINE ST STE 250
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80121-2740
Country	:	US
Telephone Number	:	720-629-4211
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER LEA DAVIES
Credential	:	L.AC.. NCMT
Telephone Number	:	720-629-4211

Provider Enumeration Date	:	08/28/2017
Last Update Date	:	09/12/2025

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