Provider Demographics
NPI:1972771830
Name:MISGELOW ENTERPRISES LLC
Entity Type:Organization
Organization Name:MISGELOW ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SPENDELOW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-777-5058
Mailing Address - Street 1:3955 E EXPOSITION AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-5000
Mailing Address - Country:US
Mailing Address - Phone:303-777-5058
Mailing Address - Fax:303-777-5058
Practice Address - Street 1:3955 E EXPOSITION AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-5000
Practice Address - Country:US
Practice Address - Phone:303-777-5058
Practice Address - Fax:303-777-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2467101YM0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU1536Medicare UPIN