Provider Demographics
NPI:1689409005
Name:LIFESPAN PSYCHIATRY OF COLORADO
Entity type:Organization
Organization Name:LIFESPAN PSYCHIATRY OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAHRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-579-0003
Mailing Address - Street 1:2140 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 N TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3554
Practice Address - Country:US
Practice Address - Phone:970-579-0003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESPAN PSYCHIATRY OF COLORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)