MEDICARE: PINE STREET 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1962372854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE STREET MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2829 NORTH AVE STE 102
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4953
Country	:	US
Telephone Number	:	970-549-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 NORTH AVE STE 102
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-4953
Country	:	US
Telephone Number	:	970-549-2877
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MR. NEIL K SANCHEZ
Credential	:	LPC, ADS
Telephone Number	:	970-549-2877

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	01/20/2026

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