Provider Demographics
NPI:1972073773
Name:MESSERLY, MISTY ANN (QMHS MA CM MA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:MESSERLY
Suffix:
Gender:F
Credentials:QMHS MA CM MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2618
Mailing Address - Country:US
Mailing Address - Phone:303-343-9890
Mailing Address - Fax:303-343-3907
Practice Address - Street 1:2178 VICTOR ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7440
Practice Address - Country:US
Practice Address - Phone:303-343-9890
Practice Address - Fax:303-343-3907
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251B00000X
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes251B00000XAgenciesCase Management