Provider Demographics
NPI:1942085188
Name:DIFFERENT HEART THERAPY, LLC
Entity Type:Organization
Organization Name:DIFFERENT HEART THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN-BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-593-9946
Mailing Address - Street 1:7500 W COAL MINE AVE APT E
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-9403
Mailing Address - Country:US
Mailing Address - Phone:215-687-0882
Mailing Address - Fax:
Practice Address - Street 1:1705 S PEARL ST STE 5
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3158
Practice Address - Country:US
Practice Address - Phone:215-687-0882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)