Provider Demographics
NPI:1790405348
Name:HEART LIGHT PSYCHIATRY LLC
Entity Type:Organization
Organization Name:HEART LIGHT PSYCHIATRY LLC
Other - Org Name:MILE HIGH PSYCHIATRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHISM
Authorized Official - Suffix:II
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:303-587-8592
Mailing Address - Street 1:3753 HOWARD HUGHES PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-0952
Mailing Address - Country:US
Mailing Address - Phone:480-847-2998
Mailing Address - Fax:720-367-5067
Practice Address - Street 1:2450 SAINT ROSE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7770
Practice Address - Country:US
Practice Address - Phone:480-847-2998
Practice Address - Fax:720-367-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty