1225653355 NPI number — BEHAVIORAL HEALTH AND TRAUMA RECOVERY SERVICES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225653355 NPI number — BEHAVIORAL HEALTH AND TRAUMA RECOVERY SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH AND TRAUMA RECOVERY SERVICES PC
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:
Provider Other Organization Name Type Code:
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:
1225653355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 WILCOX ST STE 240
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTLE ROCK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80104-1992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-945-3775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 WILCOX ST STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE ROCK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80104-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-945-3775
Provider Business Practice Location Address Fax Number:
303-985-5236
Provider Enumeration Date:
06/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LUCIA
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
303-945-3775

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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