Provider Demographics
NPI:1134689235
Name:CAROLE DIAMOND
Entity Type:Organization
Organization Name:CAROLE DIAMOND
Other - Org Name:DIAMOND BEHAVIORAL HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, NP-C
Authorized Official - Phone:970-237-5455
Mailing Address - Street 1:4128 MAIN ST
Mailing Address - Street 2:PO BOX 503
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-9997
Mailing Address - Country:US
Mailing Address - Phone:623-231-7831
Mailing Address - Fax:970-815-3775
Practice Address - Street 1:1318 S COLLEGE AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4175
Practice Address - Country:US
Practice Address - Phone:970-237-5455
Practice Address - Fax:970-815-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-23
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87873516Medicaid