Provider Demographics
NPI:1225434004
Name:JEFFERSON CENTER FOR MENTAL HEALTH
Entity Type:Organization
Organization Name:JEFFERSON CENTER FOR MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY OUTPATIENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-875-3771
Mailing Address - Street 1:6075 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1201
Mailing Address - Country:US
Mailing Address - Phone:303-875-3771
Mailing Address - Fax:
Practice Address - Street 1:4851 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6715
Practice Address - Country:US
Practice Address - Phone:303-875-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness