Provider Demographics
NPI:1942835897
Name:NORTHERN COLORADO PSYCHIATRY LLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COLLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-439-0053
Mailing Address - Street 1:PO BOX 271215
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-1215
Mailing Address - Country:US
Mailing Address - Phone:614-439-0053
Mailing Address - Fax:
Practice Address - Street 1:4786 MCMURRY AVE UNIT 2B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4499
Practice Address - Country:US
Practice Address - Phone:614-439-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty