Provider Demographics
NPI:1194473819
Name:MILE HIGH THERAPY
Entity Type:Organization
Organization Name:MILE HIGH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUZBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LPC
Authorized Official - Phone:719-231-6427
Mailing Address - Street 1:2137 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4408
Mailing Address - Country:US
Mailing Address - Phone:719-231-6427
Mailing Address - Fax:
Practice Address - Street 1:1780 S BELLAIRE ST STE 801
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4307
Practice Address - Country:US
Practice Address - Phone:719-231-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health