Provider Demographics
NPI:1144465642
Name:DEPRESSION & BIPOLAR CLINIC OF COLORADO, PLLC.
Entity type:Organization
Organization Name:DEPRESSION & BIPOLAR CLINIC OF COLORADO, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMAS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-484-5625
Mailing Address - Street 1:400 E HORSETOOTH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3189
Mailing Address - Country:US
Mailing Address - Phone:970-484-5625
Mailing Address - Fax:970-493-5131
Practice Address - Street 1:400 E HORSETOOTH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3189
Practice Address - Country:US
Practice Address - Phone:970-484-5625
Practice Address - Fax:970-493-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30397261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health