1275611329 NPI number — CANYON BEHAVIORAL HEALTH

Table of content: (NPI 1275611329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275611329 NPI number — CANYON BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANYON BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COLORADO COUNSELING PROFESSIONALS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275611329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8670 WOLFF CT
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80031-6956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-430-4010
Provider Business Mailing Address Fax Number:
303-430-5306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8670 WOLFF CT
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80031-6956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-430-4010
Provider Business Practice Location Address Fax Number:
303-430-5306
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CROUCH
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
303-430-4010

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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