Basic Information
| Provider Information | |||||||||
| NPI: | 1578722328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARAPAHOE DOUGLAS MENTAL HEALTH NETWORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 S SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801208201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037979440 | ||||||||
| FaxNumber: | 3037979354 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 S SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801208201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037979440 | ||||||||
| FaxNumber: | 3037979354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | KIRKWOOD | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CTO | ||||||||
| AuthorizedOfficialTelephone: | 3039992346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0327 | CO | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 1136-00 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 39551725 | 05 | CO | MEDICAID |