Provider Demographics
NPI:1417607334
Name:COLORADO INNOVATIVE SERVICES LLC
Entity Type:Organization
Organization Name:COLORADO INNOVATIVE SERVICES LLC
Other - Org Name:MINDHUES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:KILMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:720-654-3322
Mailing Address - Street 1:7550 E 53RD PL UNIT 5788
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-7430
Mailing Address - Country:US
Mailing Address - Phone:720-654-3322
Mailing Address - Fax:
Practice Address - Street 1:5888 BEELER CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2376
Practice Address - Country:US
Practice Address - Phone:720-654-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty