Basic Information
| Provider Information | |||||||||
| NPI: | 1174021471 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUMPET BEHAVIORAL HEALTH, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLORADO SPRINGS SOUTH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 UNION BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802286514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204142699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2989 BROADMOOR VALLEY RD STE D | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195761316 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2018 | ||||||||
| LastUpdateDate: | 02/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCHULER | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7204142699 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRUMPET BEHAVIORAL HEALTH, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 13720066 | 05 | CO | MEDICAID |