Provider Demographics
NPI:1972385508
Name:PREMIER MENTAL HEALTH HEALING PATHWAYS
Entity Type:Organization
Organization Name:PREMIER MENTAL HEALTH HEALING PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:720-525-5231
Mailing Address - Street 1:4044 EAGLE TAIL LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7927
Mailing Address - Country:US
Mailing Address - Phone:720-525-5231
Mailing Address - Fax:
Practice Address - Street 1:115 WILCOX ST STE 246
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1992
Practice Address - Country:US
Practice Address - Phone:720-525-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty