Provider Demographics
NPI:1760018956
Name:NOVIS INITIIS PSYCHOTHERAPY
Entity Type:Organization
Organization Name:NOVIS INITIIS PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:720-295-5853
Mailing Address - Street 1:PO BOX 370448
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-0448
Mailing Address - Country:US
Mailing Address - Phone:720-295-5853
Mailing Address - Fax:866-466-5083
Practice Address - Street 1:1776 S JACKSON ST STE 204
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3803
Practice Address - Country:US
Practice Address - Phone:720-295-5853
Practice Address - Fax:866-466-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty