Provider Demographics
NPI:1679306583
Name:KALEIDOSCOPE WELLNESS LTD
Entity type:Organization
Organization Name:KALEIDOSCOPE WELLNESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:COREEN
Authorized Official - Middle Name:ANN BRENNAN
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:570-772-4633
Mailing Address - Street 1:1136 E STUART ST BLDG 4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1195
Mailing Address - Country:US
Mailing Address - Phone:970-670-0913
Mailing Address - Fax:
Practice Address - Street 1:1136 E STUART ST BLDG 4
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1195
Practice Address - Country:US
Practice Address - Phone:970-670-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty