Provider Demographics
NPI:1851809123
Name:OZ PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:OZ PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:970-632-3332
Mailing Address - Street 1:2850 MCCLELLAND DR STE 3000M
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5206
Mailing Address - Country:US
Mailing Address - Phone:970-632-3332
Mailing Address - Fax:970-449-7404
Practice Address - Street 1:2850 MCCLELLAND DR STE 3000M
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5206
Practice Address - Country:US
Practice Address - Phone:970-632-3332
Practice Address - Fax:970-449-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1699050088Medicaid
CO9000162221Medicaid