Provider Demographics
NPI:1770167470
Name:HARVEST THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:HARVEST THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMFT
Authorized Official - Phone:303-921-2771
Mailing Address - Street 1:1780 S BELLAIRE ST STE 801
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4328
Mailing Address - Country:US
Mailing Address - Phone:206-539-1497
Mailing Address - Fax:720-541-6641
Practice Address - Street 1:1780 S BELLAIRE ST STE 801
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4328
Practice Address - Country:US
Practice Address - Phone:720-653-9149
Practice Address - Fax:720-541-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)