Provider Demographics
NPI:1972270916
Name:MCCOLLUM, EMILY CAROL (PMHNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CAROL
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N LINCOLN ST STE 1601
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2141
Mailing Address - Country:US
Mailing Address - Phone:720-432-9865
Mailing Address - Fax:
Practice Address - Street 1:1120 N LINCOLN ST STE 1601
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2141
Practice Address - Country:US
Practice Address - Phone:720-432-9865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1630308163W00000X
COAPN-0997819-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse