Provider Demographics
NPI:1336353481
Name:CANYON BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:CANYON BEHAVIORAL HEALTH, LLC
Other - Org Name:COLORADO COUNSELING PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PETREA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-430-4010
Mailing Address - Street 1:8670 WOLFF COURT
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031
Mailing Address - Country:US
Mailing Address - Phone:303-430-4010
Mailing Address - Fax:303-430-5406
Practice Address - Street 1:8670 WOLFF COURT
Practice Address - Street 2:SUITE 130
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031
Practice Address - Country:US
Practice Address - Phone:303-430-4010
Practice Address - Fax:303-430-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO588101YP2500X
CO783101YP2500X
CO2064103G00000X
CO1457103TC0700X
CO2395103TC0700X
CO1930103TC0700X
CO1984103TC1900X
CO2335103TC1900X
CO533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty