Provider Demographics
NPI:1770361362
Name:AUTHENTIC MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:AUTHENTIC MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:303-596-6551
Mailing Address - Street 1:12526 TAPADERO WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8135
Mailing Address - Country:US
Mailing Address - Phone:720-770-0233
Mailing Address - Fax:
Practice Address - Street 1:6400 S FIDDLERS GREEN CIR STE 300
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4950
Practice Address - Country:US
Practice Address - Phone:720-776-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty