Provider Demographics
NPI:1679330757
Name:FIDELITY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:FIDELITY BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC LAC
Authorized Official - Phone:303-667-3154
Mailing Address - Street 1:5910 S UNIVERSITY BLVD STE C18-314
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2879
Mailing Address - Country:US
Mailing Address - Phone:720-955-9887
Mailing Address - Fax:720-783-4756
Practice Address - Street 1:5910 S UNIVERSITY BLVD STE C18-314
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2879
Practice Address - Country:US
Practice Address - Phone:720-955-9887
Practice Address - Fax:720-783-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center