Provider Demographics
NPI:1659141984
Name:FIRELIGHT PSYCHIATRY
Entity Type:Organization
Organization Name:FIRELIGHT PSYCHIATRY
Other - Org Name:FIRELIGHT PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:719-428-1210
Mailing Address - Street 1:13395 VOYAGER PKWY STE 130
Mailing Address - Street 2:#1103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7677
Mailing Address - Country:US
Mailing Address - Phone:719-428-1210
Mailing Address - Fax:719-428-1211
Practice Address - Street 1:164 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319-3669
Practice Address - Country:US
Practice Address - Phone:719-428-1210
Practice Address - Fax:719-428-1211
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRELIGHT PSYCHIATRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty