Basic Information
| Provider Information | |||||||||
| NPI: | 1467503995 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFERSON CENTER FOR MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4851 INDEPENDENCE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325200 | ||||||||
| FaxNumber: | 3034325260 | ||||||||
| Practice Location | |||||||||
| Address1: | 9485 W COLFAX AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802153918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325200 | ||||||||
| FaxNumber: | 3034325260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | KEHRES | ||||||||
| AuthorizedOfficialFirstName: | M. CHRISTINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTENSIVE CASE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3034325200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2818 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.