Provider Demographics
NPI:1225409618
Name:ROCKY MOUNTAIN BEHAVIORAL MEDICINE, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN BEHAVIORAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-633-9693
Mailing Address - Street 1:11705 AIRPORT WAY STE 308
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-2711
Mailing Address - Country:US
Mailing Address - Phone:720-633-9693
Mailing Address - Fax:720-386-1086
Practice Address - Street 1:11705 AIRPORT WAY STE 308
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-2711
Practice Address - Country:US
Practice Address - Phone:720-633-9693
Practice Address - Fax:720-386-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4272103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty