Provider Demographics
NPI:1538673553
Name:MENTAL FITNESS COLORADO, LLC
Entity Type:Organization
Organization Name:MENTAL FITNESS COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUSGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, PSYCHIATRY CAQ
Authorized Official - Phone:970-682-4353
Mailing Address - Street 1:2627 REDWING RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6331
Mailing Address - Country:US
Mailing Address - Phone:970-682-4353
Mailing Address - Fax:970-530-3839
Practice Address - Street 1:2627 REDWING RD STE 220
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6331
Practice Address - Country:US
Practice Address - Phone:970-682-4353
Practice Address - Fax:970-530-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20171759951261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417043837OtherNPPES - NPI